Post-occlusive reactive hyperaemia can objectify the occurrence of vasospasm induced ischemia during acetylcholine provocation testing

Abstract Introduction Acetylcholine (ACh) spasm provocation testing together with the diagnostic criteria published by Coronary Vasomotor Disorders International Study Group (COVADIS) are considered gold standard for diagnosis of coronary vasospasm in contemporary clinical practice. In 20–29% patients undergoing an equivocal test result occurs when these only partially met and poses a dilemma. Post-occlusive reactive hyperaemia is marker acute myocardial ischemia could serve as added objective criterium acetylcholine induced vasospasm. Purpose The aim this study therefore to evaluate occurrence post-occlusive equivocal, positive negative that follows provocation. Methods 66 angina non-obstructive artery disease on angiography (ANOCA) who underwent entire ACh protocol were included analysis. After each dose was performed occurred 200 μg nitro-glycerine administered intracoronary. Definitions CAS line those used COVADIS working group diagnose epicardial microvascular An defined induction recognisable without ischemic ECG changes, reaction ACh. Doppler flow continuously measured during procedure. Changes due mediated vasodilation quickly return baseline values its short-half life. Therefore, post-ischemic assessed extended time flow, so called “flow recovery time”. Results We analysed 21 vasospasm, 16 spasm, 14 15 result. Mean age population 56±11 years 86% female. 1 3 similar between all endotypes. fourth epicardial, compared indicative hyperaemia. Conclusion These findings indicate may benefit from medical treatment. Funding Acknowledgement Type funding sources: None.