Diagnostic Validity of Acetylcholine Provocation Protocols in the Evaluation of Coronary Artery Spasm in Patients With Angina with Nonobstructive Coronary Arteries (ANOCA)
Authors' conclusion
High-dose acetylcholine provocation improves the detection of CAS in patients with ANOCA but may increase the risk of overdiagnosis. This approach should be reserved for patients with a high clinical suspicion of CAS, with the results interpreted within the broader clinical context.
Study context
- Population
- Patients with angina with nonobstructive coronary arteries (ANOCA) with typical coronary artery spasm (CAS) symptoms, and controls undergoing invasive coronary angiography for noncoronary indications62 patients with ANOCA and 20 controls · patients with ANOCA with typical CAS symptoms 62 · controls 20
- Participants
- 82 patients
- Comparison
- Conventional versus high-dose acetylcholine regimens
- Outcome
- CAS identified
Methodological detailsmultivessel acetylcholine provocation testing, control cohort
- Multivessel acetylcholine provocation testing
- Control cohort
Performance
As reported in the abstract
Further findings
Diagnostic performance
Sensitivity
Specificity
Negative predictive value
Positive predictive value
- Diagnostic performance: sensitivity P =0.008
- Diagnostic performance: specificity P =0.08 (nonsignificant trend toward lower specificity with high dose)
- Diagnostic performance: negative predictive value P =0.01
- Diagnostic performance: positive predictive value P =0.12
Typical angina consistent with CAS among patients with inducible spasm
- Among patients with inducible spasm, typical angina consistent with CAS
- 93.4% (61/65)
Original publication
Diagnostic Validity of Acetylcholine Provocation Protocols in the Evaluation of Coronary Artery Spasm in Patients With ANOCA. Circ Cardiovasc Interv. Published 25 June 2025. doi:10.
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