Published online Jan 26, 2024. doi: 10.4330/wjc.v16.i1.16
Peer-review started: September 27, 2023
First decision: November 28, 2023
Revised: December 11, 2023
Accepted: December 28, 2023
Article in press: December 28, 2023
Published online: January 26, 2024
Although the spasm provocation test (SPT) can diagnose coronary spasms, it would be helpful if it could also predict their occurrence.
To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.
Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure. During each SPT, the pressure wire was advanced into the distal portion of the right coronary artery (RCA) and left anterior de
Among the 132 coronary arteries assessed using a pressure wire, there were 49 in group N, 25 in group L, and 58 in group MH. Baseline Pd/Pa was the lowest in group L (P = 0.001). The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N (P < 0.001). A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95, with a sensitivity of 0.600 (15/25) and a specificity of 0.713 (76/107) and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was −0.04, with a sensitivity of 0.741 (43/58) and a specificity of 0.694 (34/49).
These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.
Core Tip: The spasm provocation test (SPT) is a well-established tool for diagnosing coronary spasms. However, it is associated with several complications that can make the test a stressful experience. We investigated whether coronary spasms detected in the SPT can be estimated using intracoronary artery pressure measured with a pressure wire. We found that coronary spasms induced by low acetylcholine doses were associated with decreased intracoronary pressure at baseline. Coronary spasms induced by moderate-to-high acetylcholine doses showed decreased intracoronary pressure from baseline to low acetylcholine doses. These indices of intracoronary pressure may be used to predict coronary spasms.