Discrepancy Between Effect of Acetylcholine and Ergonovine on Coronary Arterial Vasoconstriction in Patients With Ischemic Heart Disease

The present study was aimed to elucidate the discrepancy of coronary vasoconstrictor effect between acetylcholine and ergonovine. The subjects consisted of 78 patients with ischemic heart disease; 15 out of them had variant angina, 16 typical rest angina, 24 effort angina, 13 old myocardial infarction, and 10 unexplained syncope. In the spasm provocation, the acetylcholine was intracoronaryly injected and followed by the ergonovine in the same way, as the acetylcholine-induced coronary spasm can be resolved spontaneously without nitrate administration. When total or subtotal occlusion occurred in the coronary arteriogram, the provocation test was defined as a positive finding. The coronary artery spasm was provoked in 35 (45%) patients either by acetylcholine or ergonovine. In 22 out of them, the spasm occurred by both agents. In 13 out of those 35 patients, a discrepancy between the effect of acetylcholine and that of ergonovine was observed; in 5 patients the spasm was provoked only by ergonovine and not by acetylcholine, and in the other 8 patients the spasm was provoked only by acetylcholine. In patients with variant angina, 10 cases showed a similar response, two showed the discrepant response: the provocation only by ergonovine was positive in these cases. In the other groups of patients, 13 showed a similar response, and 11 showed the discrepant response. In 8 out of those 11 patients the provocation only by acetylcholine was positive. These results indicate that coronary artery can react to acetylcholine and ergonovine in a different way even if the patients belong to the variant angina group. In conclusion, it will be recommended that when the coronary spasm can not be provoked by the acetylcholine, the ergonovine test is requested to exclude the false-negative response