Marrone Andrea, Pavasini Rita, Scollo Ennio, Gibiino Federico, Pompei Graziella, Caglioni Serena, Biscaglia Simone, Campo Gianluca, Tebaldi Matteo
Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy.
J Clin Med. 2022 Feb 21;11(4):1129. doi: 10.3390/jcm11041129.
The use of acetylcholine for the diagnosis of vasospastic angina is recommended by international guidelines. However, its intracoronary use is still off-label due to the absence of safety studies. We aimed to perform a systematic review of the literature to identify adverse events related to the intracoronary administration of acetylcholine for vasoreactivity testing to fill this gap.
We conducted a systematic review of observational studies and randomized controlled trials dealing with the intracoronary administration of acetylcholine. Articles were searched in MEDLINE (PubMed) using the MeSH strategy. Three independent reviewers determined whether the studies met the inclusion and exclusion criteria. A total of 434 articles were selected. Data concerning clinical characteristics, study population, acetylcholine dosage, and adverse effects were retrieved from the articles. Overall, 71,566 patients were included, of which only 382 (0.5%) developed one adverse event, and there were no fatal events reported (0%).
Intracoronary administration of acetylcholine in the setting of coronary spasm provocation testing is safe and plays a central role in the evaluation of coronary vasomotion disorders, making it worthy of becoming a part of clinical practice in all cardiac catheterization laboratories.
国际指南推荐使用乙酰胆碱诊断血管痉挛性心绞痛。然而，由于缺乏安全性研究，其冠状动脉内使用仍属于超说明书用药。我们旨在对文献进行系统综述，以确定与冠状动脉内注射乙酰胆碱进行血管反应性测试相关的不良事件，从而填补这一空白。
我们对涉及冠状动脉内注射乙酰胆碱的观察性研究和随机对照试验进行了系统综述。使用医学主题词（MeSH）策略在MEDLINE（PubMed）中检索文章。三位独立评审员确定这些研究是否符合纳入和排除标准。共筛选出434篇文章。从这些文章中获取了有关临床特征、研究人群、乙酰胆碱剂量和不良反应的数据。总体而言，纳入了71566例患者，其中仅382例（0.5%）发生了1次不良事件，未报告致命事件（0%）。
在冠状动脉痉挛激发试验中冠状动脉内注射乙酰胆碱是安全的，并且在评估冠状动脉血管运动障碍中起着核心作用，使其值得成为所有心脏导管实验室临床实践的一部分。
