Do changes in intracoronary pressure aid coronary spasm diagnosis using the spasm provocation test?

Table 1 Patients’ characteristics

	Non-VSA	VSA	P value
n (%)	17 (24)	53 (18)
Age (yr)	68 ± 10	68 ± 9	0.775
Male/Female	3/14	33/20	0.001
Body mass index	24.4 ± 4.1	24.5 ± 3.8	0.914
Coronary risk factors (%)
Smoking (active/former/never)	2/2/13	11/16/26	0.134
Hypertension	14 (82)	39 (74)	0.463
Dyslipidemia	11 (65)	32 (60)	0.750
Diabetes mellitus	4 (24)	18 (34)	0.420
Alcohol consumer (%)	10 (13)	5 (29)	0.09
Family history of CAD (%)	4 (24)	14 (26)	0.813
CKD (%)	7 (41)	17 (32)	0.492
LVEF on UCG (%)	69 ± 7	66 ± 9	0.200
Brachial artery ultrasonography (n)	14	48
Brachial artery diameter at baseline (mm)	3.8 ± 0.8	3.9 ± 0.7	0.711
FMD (%)	6.2 ± 4.8	3.0 ± 3.6	0.008
NID (%)	17.7 ± 7.7	13.6 ± 6.9	0.061
Medications
Any kind of coronary vasodilator (%)	13 (76)	23 (43)	0.018
No. of coronary vasodilators	1 (0.5, 1)	0 (0, 1)	0.059
Beta-receptor blockers (%)	1 (6)	4 (8)	0.817
RAS inhibitors (%)	7 (41)	12 (23)	0.135
Lipid-lowering drugs (%)	4 (41)	17 (32)	0.492
Anti-platelet drugs (%)	4 (24)	18 (34)	0.420

CAD: Coronary artery disease; CKD: Chronic kidney disease; FMD: Flow-mediated dilation; LVEF: Left ventricular ejection fraction; NID: Nitroglycerin-induced dilation; RAS: Renin-angiotensin system; UCG: Cardiac ultrasonography; VSA: Vasospastic angina.

Table 2 Characteristics of lesions based on the occurrence of coronary spasms during spasm provocation tests and the dose of acetylcholine

	Group N	Group L	Group MH	P value
n	49	25	58
RCA/LAD	27/22	9/16	27/31	0.290
Atherosclerosis (%)	23 (47)	9 (36)	28 (48)	0.568
Unavoidable use of NTG	4 (8)	3 (12)	5 (9)	0.851
Coronary spasm
Focal/diffuse		8/17	14/44
Proximal/mid/distal		4/15/6	5/35/18
iFR	0.98 ± 0.04	0.92 ± 0.09	0.98 ± 0.06	0.104
n	15	5	11
Pd/Pa
Baseline	0.98 ± 0.04	0.94 ± 0.05	0.96 ± 0.05	0.001
Low dose of ACh	0.96 ± 0.05	0.72 ± 0.14	0.90 ± 0.06	< 0.001
Pd/Pa (Low dose-baseline)	−0.03 ± 0.03	−0.22 ± 0.14	−0.06 ± 0.05	< 0.001
Moderate-high doses of ACh	0.93 ± 0.06		0.78 ± 0.13	< 0.001
FFR	1.01	0.81 ± 0.09	0.87 ± 0.09	0.093
n	1	6	13

Coronary arteries with coronary spasms at low doses of Acetylcholine (Ach) were defined as group L, and those with coronary spasms at moderate or high doses were defined as group MH. Those who did not occur coronary spasms at any ACh dose were designated as group N. ACh: Acetylcholine; FFR: Fractional flow reserve; iFR: Instantaneous free-wave ratio; LAD: Left anterior descending coronary artery; NTG: Nitroglycerin; Pa: Aortic pressure; Pd: Distal pressure; RCA: Right coronary artery.