Standard

Acetylcholine Rechallenge : A First Step Toward Tailored Treatment in Patients With Coronary Artery Spasm. / Seitz, Andreas; Feenstra, Rutger; Konst, Regina E. et al.

In: JACC. Cardiovascular interventions, Vol. 15, No. 1, 10.01.2022, p. 65-75.

Research output: Contribution to journalArticleAcademicpeer-review

Harvard

Seitz, A, Feenstra, R, Konst, RE, Martínez Pereyra, V, Beck, S, Beijk, M, van de Hoef, T, van Royen, N, Bekeredjian, R, Sechtem, U, Damman, P, Piek, JJ & Ong, P 2022, 'Acetylcholine Rechallenge: A First Step Toward Tailored Treatment in Patients With Coronary Artery Spasm', JACC. Cardiovascular interventions, vol. 15, no. 1, pp. 65-75. https://doi.org/10.1016/j.jcin.2021.10.003

APA

Seitz, A., Feenstra, R., Konst, R. E., Martínez Pereyra, V., Beck, S., Beijk, M., van de Hoef, T., van Royen, N., Bekeredjian, R., Sechtem, U., Damman, P., Piek, J. J., & Ong, P. (2022). Acetylcholine Rechallenge: A First Step Toward Tailored Treatment in Patients With Coronary Artery Spasm. JACC. Cardiovascular interventions, 15(1), 65-75. https://doi.org/10.1016/j.jcin.2021.10.003

Vancouver

Seitz A, Feenstra R, Konst RE, Martínez Pereyra V, Beck S, Beijk M et al. Acetylcholine Rechallenge: A First Step Toward Tailored Treatment in Patients With Coronary Artery Spasm. JACC. Cardiovascular interventions. 2022 Jan 10;15(1):65-75. https://doi.org/10.1016/j.jcin.2021.10.003

Author

Seitz, Andreas ; Feenstra, Rutger ; Konst, Regina E. et al. / Acetylcholine Rechallenge : A First Step Toward Tailored Treatment in Patients With Coronary Artery Spasm. In: JACC. Cardiovascular interventions. 2022 ; Vol. 15, No. 1. pp. 65-75.

BibTeX

@article{8dbd2ad04b4b4e78ac86b200c1f6ef90,
title = "Acetylcholine Rechallenge: A First Step Toward Tailored Treatment in Patients With Coronary Artery Spasm",
abstract = "Objectives: The present study aimed to assess the feasibility and clinical value of acetylcholine (ACh) rechallenge for the detection of coexisting epicardial and microvascular spasm and to determine the efficacy of nitroglycerin in these spasm endotypes. Background: The coexistence of epicardial and microvascular spasm is difficult to identify; thus, its frequency is unknown. Nitroglycerin treatment is equally recommended for both epicardial and microvascular coronary spasm despite contradictory data. Methods: In this multicenter study, 95 patients with coronary spasm were included to undergo ACh rechallenge, which consisted of repeated ACh provocation 3 minutes after intracoronary nitroglycerin administration using the same dose that previously induced spasm. Results: In total, 95 patients (age 61 ± 12 years, 69% female) were included. Fifty-five patients (58%) had microvascular spasm, and 40 patients (42%) had epicardial spasm during initial ACh provocation. In 48% of patients with epicardial spasm, ACh rechallenge revealed coexisting nitroglycerin-persistent microvascular spasm. Nitroglycerin administration before ACh rechallenge prevented reinducibility of epicardial spasm in all patients with focal spasm and in 80% of patients with diffuse spasm. Microvascular spasm was prevented in only 20% by prior nitroglycerin administration but was attenuated in another 49% of patients. Conclusions: This study demonstrates a high frequency of epicardial spasm with coexisting nitroglycerin-persistent microvascular spasm. Intracoronary nitroglycerin was very effective in preventing reinducibility of epicardial spasm, whereas it prevented microvascular spasm in only 20% of patients. ACh rechallenge is a novel method that facilitates the detection of coexisting spasm endotypes and may pave the way towards tailored treatment of vasospastic angina.",
keywords = "coronary spasm, coronary vasomotor disorders, functional coronary disorder, microvascular dysfunction, nitroglycerin",
author = "Andreas Seitz and Rutger Feenstra and Konst, {Regina E.} and {Mart{\'i}nez Pereyra}, Valeria and Sascha Beck and Marcel Beijk and {van de Hoef}, Tim and {van Royen}, Niels and Raffi Bekeredjian and Udo Sechtem and Peter Damman and Piek, {Jan J.} and Peter Ong",
note = "Funding Information: This study was supported by the Robert Bosch Foundation, Stuttgart, Germany, and the Berthold Leibinger Foundation, Ditzingen, Germany. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",
year = "2022",
month = jan,
day = "10",
doi = "10.1016/j.jcin.2021.10.003",
language = "English",
volume = "15",
pages = "65--75",
journal = "JACC. Cardiovascular interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "1",

}

RIS

TY - JOUR

T1 - Acetylcholine Rechallenge

T2 - A First Step Toward Tailored Treatment in Patients With Coronary Artery Spasm

AU - Seitz, Andreas

AU - Feenstra, Rutger

AU - Konst, Regina E.

AU - Martínez Pereyra, Valeria

AU - Beck, Sascha

AU - Beijk, Marcel

AU - van de Hoef, Tim

AU - van Royen, Niels

AU - Bekeredjian, Raffi

AU - Sechtem, Udo

AU - Damman, Peter

AU - Piek, Jan J.

AU - Ong, Peter

N1 - Funding Information: This study was supported by the Robert Bosch Foundation, Stuttgart, Germany, and the Berthold Leibinger Foundation, Ditzingen, Germany. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2022 American College of Cardiology Foundation

PY - 2022/1/10

Y1 - 2022/1/10

N2 - Objectives: The present study aimed to assess the feasibility and clinical value of acetylcholine (ACh) rechallenge for the detection of coexisting epicardial and microvascular spasm and to determine the efficacy of nitroglycerin in these spasm endotypes. Background: The coexistence of epicardial and microvascular spasm is difficult to identify; thus, its frequency is unknown. Nitroglycerin treatment is equally recommended for both epicardial and microvascular coronary spasm despite contradictory data. Methods: In this multicenter study, 95 patients with coronary spasm were included to undergo ACh rechallenge, which consisted of repeated ACh provocation 3 minutes after intracoronary nitroglycerin administration using the same dose that previously induced spasm. Results: In total, 95 patients (age 61 ± 12 years, 69% female) were included. Fifty-five patients (58%) had microvascular spasm, and 40 patients (42%) had epicardial spasm during initial ACh provocation. In 48% of patients with epicardial spasm, ACh rechallenge revealed coexisting nitroglycerin-persistent microvascular spasm. Nitroglycerin administration before ACh rechallenge prevented reinducibility of epicardial spasm in all patients with focal spasm and in 80% of patients with diffuse spasm. Microvascular spasm was prevented in only 20% by prior nitroglycerin administration but was attenuated in another 49% of patients. Conclusions: This study demonstrates a high frequency of epicardial spasm with coexisting nitroglycerin-persistent microvascular spasm. Intracoronary nitroglycerin was very effective in preventing reinducibility of epicardial spasm, whereas it prevented microvascular spasm in only 20% of patients. ACh rechallenge is a novel method that facilitates the detection of coexisting spasm endotypes and may pave the way towards tailored treatment of vasospastic angina.

AB - Objectives: The present study aimed to assess the feasibility and clinical value of acetylcholine (ACh) rechallenge for the detection of coexisting epicardial and microvascular spasm and to determine the efficacy of nitroglycerin in these spasm endotypes. Background: The coexistence of epicardial and microvascular spasm is difficult to identify; thus, its frequency is unknown. Nitroglycerin treatment is equally recommended for both epicardial and microvascular coronary spasm despite contradictory data. Methods: In this multicenter study, 95 patients with coronary spasm were included to undergo ACh rechallenge, which consisted of repeated ACh provocation 3 minutes after intracoronary nitroglycerin administration using the same dose that previously induced spasm. Results: In total, 95 patients (age 61 ± 12 years, 69% female) were included. Fifty-five patients (58%) had microvascular spasm, and 40 patients (42%) had epicardial spasm during initial ACh provocation. In 48% of patients with epicardial spasm, ACh rechallenge revealed coexisting nitroglycerin-persistent microvascular spasm. Nitroglycerin administration before ACh rechallenge prevented reinducibility of epicardial spasm in all patients with focal spasm and in 80% of patients with diffuse spasm. Microvascular spasm was prevented in only 20% by prior nitroglycerin administration but was attenuated in another 49% of patients. Conclusions: This study demonstrates a high frequency of epicardial spasm with coexisting nitroglycerin-persistent microvascular spasm. Intracoronary nitroglycerin was very effective in preventing reinducibility of epicardial spasm, whereas it prevented microvascular spasm in only 20% of patients. ACh rechallenge is a novel method that facilitates the detection of coexisting spasm endotypes and may pave the way towards tailored treatment of vasospastic angina.

KW - coronary spasm

KW - coronary vasomotor disorders

KW - functional coronary disorder

KW - microvascular dysfunction

KW - nitroglycerin

UR - http://www.scopus.com/inward/record.url?scp=85121619941&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2021.10.003

DO - 10.1016/j.jcin.2021.10.003

M3 - Article

C2 - 34991826

VL - 15

SP - 65

EP - 75

JO - JACC. Cardiovascular interventions

JF - JACC. Cardiovascular interventions

SN - 1936-8798

IS - 1

ER -

ID: 20972966