Schäufele Tim, Nobre Menezes Miguel, Schulte Steinberg Benedict, Hubert Astrid, Martínez Pereyra Valeria, Arndt Helene, Sechtem Udo, Bekeredjian Raffi, Ong Peter
Department of Cardiology, Lindenhofspital Bern, Switzerland.
Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, and CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Int J Cardiol. 2025 Jan 15;419:132703. doi: 10.1016/j.ijcard.2024.132703. Epub 2024 Nov 2.
Invasive coronary angiography via the radial approach is commonly performed following radial artery spasm prophylaxis (RASP). It is however unknown, whether RASP influences the results of coronary spasm provocation testing performed after diagnostic angiography. We aimed to investigate the effects of RASP on vasomotor responses during intracoronary acetylcholine (ACh) testing.
We retrospectively screened 372 consecutive patients (51 % female, mean age 61 ± 11 years) with angina and non-obstructive coronary arteries, who underwent intracoronary provocation with ACh according to a standardized protocol. During testing, dose-dependent clinical discomfort and concomitant ischemic electrocardiographic changes were recorded in addition to visual reductions of epicardial lumen diameters. Of these patients, 156 (42 %) received RASP (i.e. 200 μg nitroglycerin and 2.5 mg verapamil), while no RASP was administered in 216 (58 %) patients. Both groups were compared regarding age, sex, cardiovascular risk factors and ACh-test results.
ACh provocation testing revealed a pathological test result in 71 patients (46 %) with RASP and 103 patients (48 %) without (p = 0.752) [epicardial spasm: in 20 patients (28 %) with RASP and 42 patients (41 %) without (p = 0.120); microvascular spasm: in 51 patients (72 %) with RASP and 61 patients (59 %) without (p = 0.362)]. Overall, RASP did not significantly alter coronary artery vasomotor responses, neither regarding the frequency (p = 0.752) or type of coronary spasm (microvascular vs. epicardial; p = 0.108) nor regarding the ACh dose leading to spasm (p = 0.151).
RASP does not significantly affect coronary vasomotor responses to ACh, suggesting that radial artery spasm prophylaxis can be routinely administered even in patients in whom intracoronary spasm testing is performed.
在采取桡动脉痉挛预防措施（RASP）后，通常会经桡动脉途径进行有创冠状动脉造影。然而，RASP是否会影响诊断性血管造影后进行的冠状动脉痉挛激发试验的结果尚不清楚。我们旨在研究RASP对冠状动脉内乙酰胆碱（ACh）试验期间血管舒缩反应的影响。
我们回顾性筛选了372例连续的心绞痛且冠状动脉无阻塞的患者（51%为女性，平均年龄61±11岁），这些患者按照标准化方案接受了冠状动脉内ACh激发试验。在试验期间，除了观察心外膜管腔直径的视觉减小外，还记录了剂量依赖性临床不适和伴随的缺血性心电图变化。在这些患者中，156例（42%）接受了RASP（即200μg硝酸甘油和2.5mg维拉帕米），而216例（58%）患者未接受RASP。比较了两组患者的年龄、性别、心血管危险因素和ACh试验结果。
ACh激发试验显示，接受RASP的71例患者（46%）和未接受RASP的103例患者（48%）出现病理性试验结果（p=0.752）[心外膜痉挛：接受RASP的20例患者（28%）和未接受RASP的42例患者（41%）（p=0.120）；微血管痉挛：接受RASP的51例患者（72%）和未接受RASP的61例患者（59%）（p=0.362）]。总体而言，RASP并未显著改变冠状动脉血管舒缩反应，无论是冠状动脉痉挛的频率（p=0.752）或类型（微血管痉挛与心外膜痉挛；p=0.108），还是导致痉挛的ACh剂量（p=0.151）。
RASP不会显著影响冠状动脉对ACh的血管舒缩反应，这表明即使在进行冠状动脉内痉挛试验的患者中，也可以常规进行桡动脉痉挛预防。
