Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Cardiology, Concord Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Central Adelaide Local Health Network, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia.
J Cardiol. 2024 Jan;83(1):8-16. doi: 10.1016/j.jjcc.2023.07.020. Epub 2023 Aug 3.
Coronary provocation testing is an essential diagnostic procedure when evaluating vasospastic angina. Invasive methods using acetylcholine or ergonovine are considered the current gold standard. Despite efforts from global cardiovascular institutions, current protocols vary in dosage, administration time, and procedural approach. In addition, concerns over the specificity of findings and potential complications have limited routine uptake of this procedure in clinical practice. This systematic review evaluates current diagnostic protocols, focusing on invasive provocation testing. We included studies using intracoronary provocation testing with acetylcholine or ergonovine for the assessment of coronary artery vasospasm that detailed specific elements of the procedure (dosage, administration time, etc.) and included ≥50 patients. A total of 28 articles met strict inclusion criteria. Our review highlights the heterogeneity between current diagnostic protocols for invasive provocation testing. We believe standardization of a diagnostic protocol will encourage both current and future cardiologists to incorporate such procedures in the evaluation of variant angina.
当评估血管痉挛性心绞痛时，冠状动脉激发试验是一种基本的诊断程序。使用乙酰胆碱或麦角新碱的有创方法被认为是目前的金标准。尽管全球心血管机构做出了努力，但目前的方案在剂量、给药时间和操作方法上存在差异。此外，对发现结果的特异性和潜在并发症的担忧限制了该程序在临床实践中的常规应用。本系统评价评估了当前的诊断方案，重点是有创激发试验。我们纳入了使用乙酰胆碱或麦角新碱进行冠状动脉痉挛评估的经皮冠状动脉内激发试验的研究，这些研究详细说明了该程序的具体内容（剂量、给药时间等），并纳入了≥50 例患者。共有 28 篇文章符合严格的纳入标准。我们的综述强调了目前有创激发试验诊断方案之间的异质性。我们认为诊断方案的标准化将鼓励当前和未来的心脏病专家将这些程序纳入变异性心绞痛的评估中。
