Okumura K, Yasue H, Matsuyama K, Goto K, Miyagi H, Ogawa H, Matsuyama K
Division of Cardiology, Kumamoto University Medical School, Japan.
J Am Coll Cardiol. 1988 Oct;12(4):883-8. doi: 10.1016/0735-1097(88)90449-4.
Intracoronary injection of acetylcholine has been shown to induce coronary spasm in patients with variant angina. To examine its sensitivity and specificity, incremental doses of acetylcholine (20, 50 and 100 micrograms into the left coronary artery and 20 and 50 micrograms into the right coronary artery) were injected into the coronary artery or arteries in 70 patients with variant angina (Group 1) (mean age 57 years) and 93 patients without variant angina or angina at rest (Group 2) (mean age 54 years). Forty patients of the latter group had atypical chest pain, 16 cardiomyopathy, 14 arrhythmia, 11 valvular disease, 7 stable effort angina due to advanced coronary artery disease, 3 congenital heart disease and 2 hypertension. A temporary cardiac pacemaker set at 40 to 50 beats/min was positioned in the right ventricle. Coronary spasm was defined as total occlusion or severe vasoconstriction associated with chest pain or ischemic ST changes on the electrocardiogram or both. In Group 1, acetylcholine induced spasm in 63 (90%) of the 70 patients in the artery or arteries predicted to be responsible for spontaneous attacks. In Group 2, acetylcholine induced coronary spasm only in one patient with effort angina and advanced coronary artery disease although lesser degrees of vasoconstriction (less than or equal to 75% of the luminal diameter) occurred in most patients after acetylcholine (specificity of acetylcholine thus was 99%). In conclusion, intracoronary injection of acetylcholine is sensitive and reliable for the induction of coronary spasm.
冠状动脉内注射乙酰胆碱已被证明可诱发变异型心绞痛患者的冠状动脉痉挛。为了检测其敏感性和特异性，对70例变异型心绞痛患者（第1组，平均年龄57岁）和93例无变异型心绞痛或静息性心绞痛的患者（第2组，平均年龄54岁）的一条或多条冠状动脉内注射递增剂量的乙酰胆碱（左冠状动脉注射20、50和100微克，右冠状动脉注射20和50微克）。后一组中的40例患者有非典型胸痛，16例有心肌病，14例有心律失常，11例有瓣膜病，7例因严重冠状动脉疾病导致稳定型劳力性心绞痛，3例有先天性心脏病，2例有高血压。将临时心脏起搏器设置为每分钟40至50次心跳，置于右心室。冠状动脉痉挛定义为与胸痛或心电图上的缺血性ST段改变或两者相关的完全闭塞或严重血管收缩。在第1组中，乙酰胆碱在预计会引发自发性发作的一条或多条动脉中，诱发了70例患者中63例（90%）的痉挛。在第2组中，乙酰胆碱仅在1例劳力性心绞痛和严重冠状动脉疾病患者中诱发了冠状动脉痉挛，尽管大多数患者在注射乙酰胆碱后出现了较轻程度的血管收缩（管腔直径缩小小于或等于75%）（因此乙酰胆碱的特异性为99%）。总之，冠状动脉内注射乙酰胆碱对于诱发冠状动脉痉挛是敏感且可靠的。
