Importance of a second spasm provocation test: Four cases with an initial negative spasm provocation test

Abstract

The spasm provocation test (SPT) is an important test in the diagnosis of vasospastic angina (VSA). In many cases, this test is performed as the gold standard test, and VSA is considered not present if the SPT is negative. However, some patients continue to experience chest symptoms despite a negative SPT. In this study, we report four cases in which SPT was repeated to evaluate chest symptoms despite the negative results of the first SPT. Two men in their 70s, one woman in her 60s, and one woman in her 70s, all with chest symptoms, underwent a second SPT at 4, 3, 2, and 3 years, respectively, after the first SPT, which was negative. Three patients had positive results in the second SPT (75%). In conclusion, even when SPT is negative, the diagnosis of VSA should be made with clinical symptoms in consideration. In some cases, a second SPT may be required to confirm the diagnosis of VSA.

Keywords: Coronary spasm; Acetylcholine; Spasm provocation test; Pressure wire

Core tip: The spasm provocation test (SPT) is an important examination when diagnosing vasospastic angina (VSA). In general, if the SPT is negative, VSA is considered not present. However, we encountered four patients who underwent a second SPT although the first SPT was negative. In these patients, some show a positive second SPT result. SPT is not a perfect examination, and in the clinical setting, the diagnosis of VSA should be made with the consideration of their clinical symptoms and examinations.