冠状动脉痉挛诊断的冠状动脉内激发试验的安全性。
Safety of intracoronary provocative testing for the diagnosis of coronary artery spasm.
机构信息
Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, United Kingdom; Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy; Department of Cardiovascular Sciences, Marche Polytechnic University, Ancona, Italy.
Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, United Kingdom.
出版信息
Int J Cardiol. 2017 Oct 1;244:77-83. doi: 10.1016/j.ijcard.2017.05.109. Epub 2017 Jun 1.
AIMS
Systematic review of literature to evaluate safety of intracoronary (i.c.) pharmacologic testing with acetylcholine (ACh), or ergonovine (ERGO), to induce coronary artery spasm.
METHODS AND RESULTS
Review of all relevant publications using MEDLINE and EMBASE databases yielded 10 publications, totalling 9,444 patients. Prevalence of provoked spasm varied from 2.3% to 54.7% of patients tested in the selected studies. The wide variability in prevalence was due to heterogeneity of study populations and provocation protocols. No deaths were reported. Overall occurrence of major (0.8%) and minor (4.7%) complications for i.c. pharmacologic testing was low. Compared to ERGO, ACh showed significantly higher rate of major (1.09% vs 0.15%; p<0.001) and minor complications (5.87% vs 2.36%; p<0.001).
CONCLUSION
Provocative testing with i.c. ACh or ERGO are safe and can facilitate the diagnosis of inducible coronary artery spasm during diagnostic coronary angiography. These tests should be part of the routine armamentarium of interventional cardiologists.
目的
系统评价文献，评估冠状动脉内（i.c.）应用乙酰胆碱（ACh）或麦角新碱（ERGO）进行药理学检查诱发冠状动脉痉挛的安全性。
方法和结果
使用 MEDLINE 和 EMBASE 数据库对所有相关文献进行了综述，共纳入 10 项研究，总计 9444 例患者。在入选的研究中，经检查诱发痉挛的患者比例从 2.3%到 54.7%不等。这种流行率的广泛差异是由于研究人群和激发方案的异质性所致。研究中未报告死亡病例。总的来说，冠状动脉内药理学检查的主要（0.8%）和次要（4.7%）并发症发生率较低。与 ERGO 相比，ACh 引起的主要（1.09% vs 0.15%；p<0.001）和次要并发症（5.87% vs 2.36%；p<0.001）发生率显著更高。
结论
冠状动脉内应用 ACh 或 ERGO 进行激发检查安全有效，可在诊断性冠状动脉造影期间有助于诊断可诱导性冠状动脉痉挛。这些检查应成为介入心脏病学家常规治疗手段的一部分。
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