Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Internal Medicine, Division of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Acta Cardiol. 2021 Feb;76(1):38-45. doi: 10.1080/00015385.2019.1687966. Epub 2019 Nov 9.
Intracoronary (IC) provocation angiography is recommended when variant angina is suspected. However, specific procedure-related factors remain uncertain.
Intracoronary ergonovine infusion was used for the provocation test. About 10, 20, and 40 μg of ergonovine were sequentially injected into the right coronary artery (RCA). During a negative or intermediate response or depending on the clinician's discretion, the left coronary artery (LCA) was injected with incremental doses of 20, 40, and 80 μg of ergonovine or vice versa. If significant coronary spasm or positive clinical findings were noted, the test was stopped immediately and IC nitroglycerine was injected.
We reviewed a total of 725 patients (male: 402; mean age: 58.5 years). Spasm-positive response was observed in 269 patients (37.1%), intermediate response in 113 patients (15.6%), and negative response in 343 patients (47.3%). The right radial artery approach was used in most cases (92.6%), and the RCA first approach was mainly chosen (95.0%). The provocation results in the RCA and LCA (93.4%, 381/408) were highly consistent, and the clinically significant discrepancy rate (RCA positive/LCA negative or RCA negative/LCA positive) was 1.5% (6/408). The RCA-alone provocation test can identify spasm-positive response in 93.4% of the patients (228/244). The mean procedure time was 39.9 ± 11.0 min, and approximately 3.3% (24/725) of the patients developed acute complications.
The RCA-first IC ergonovine provocation test is feasible, and the RCA-alone spasm provocation could be acceptable except in an intermediate response, highly clinically suspected cases, or high-risk patients.
当怀疑变异性心绞痛时，建议进行冠状动脉内（IC）激发血管造影。然而，特定的与操作相关的因素仍不确定。
使用 IC 麦角新碱输注进行激发试验。约 10、20 和 40μg 麦角新碱依次注入右冠状动脉（RCA）。在阴性或中间反应时，或根据临床医生的判断，左冠状动脉（LCA）注入递增剂量的 20、40 和 80μg 麦角新碱，或反之亦然。如果注意到明显的冠状动脉痉挛或阳性的临床发现，试验立即停止并注入 IC 硝酸甘油。
我们共回顾了 725 例患者（男性：402 例；平均年龄：58.5 岁）。269 例（37.1%）患者出现痉挛阳性反应，113 例（15.6%）患者出现中间反应，343 例（47.3%）患者出现阴性反应。大多数情况下采用右桡动脉入路（92.6%），主要选择 RCA 首先入路（95.0%）。RCA 和 LCA 的激发结果（93.4%，381/408）高度一致，临床显著差异率（RCA 阳性/LCA 阴性或 RCA 阴性/LCA 阳性）为 1.5%（6/408）。单独 RCA 激发试验可识别 93.4%（228/244）的痉挛阳性反应患者。平均操作时间为 39.9±11.0min，约 3.3%（24/725）的患者发生急性并发症。
RCA 首先的 IC 麦角新碱激发试验是可行的，除中间反应、高度疑似病例或高危患者外，单独 RCA 痉挛激发也可以接受。
