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Review
. 2022 Feb 21;11(4):1129.
doi: 10.3390/jcm11041129.

Acetylcholine Use in Modern Cardiac Catheterization Laboratories: A Systematic Review

Andrea Marrone  1 , Rita Pavasini  1 , Ennio Scollo  1 , Federico Gibiino  1 , Graziella Pompei  1 , Serena Caglioni  1 , Simone Biscaglia  1 , Gianluca Campo  1 , Matteo Tebaldi  1
Affiliations
Review

Acetylcholine Use in Modern Cardiac Catheterization Laboratories: A Systematic Review

Andrea Marrone et al. J Clin Med. .

Abstract

Background: The use of acetylcholine for the diagnosis of vasospastic angina is recommended by international guidelines. However, its intracoronary use is still off-label due to the absence of safety studies. We aimed to perform a systematic review of the literature to identify adverse events related to the intracoronary administration of acetylcholine for vasoreactivity testing to fill this gap.

Methods and results: We conducted a systematic review of observational studies and randomized controlled trials dealing with the intracoronary administration of acetylcholine. Articles were searched in MEDLINE (PubMed) using the MeSH strategy. Three independent reviewers determined whether the studies met the inclusion and exclusion criteria. A total of 434 articles were selected. Data concerning clinical characteristics, study population, acetylcholine dosage, and adverse effects were retrieved from the articles. Overall, 71,566 patients were included, of which only 382 (0.5%) developed one adverse event, and there were no fatal events reported (0%).

Conclusions: Intracoronary administration of acetylcholine in the setting of coronary spasm provocation testing is safe and plays a central role in the evaluation of coronary vasomotion disorders, making it worthy of becoming a part of clinical practice in all cardiac catheterization laboratories.

Keywords: acetylcholine provocation test; coronary spasm; diffuse spasm; prognosis; safety; vasospastic angina.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Outline of the search strategy.
Figure 2
Figure 2
Incidence of adverse events. AF: atrial fibrillation; AV: atrial ventricular, MI: myocardial infarction, NSVT: non-sustained ventricular fibrillation, SVT: sustained ventricular fibrillation; VF: ventricular fibrillation.
Figure 3
Figure 3
Central illustration: incidence of adverse events in patients evaluated with coronary acetylcholine.
See this image and copyright information in PMC

References

    1. Beltrame J.F., Crea F., Kaski J.C., Ogawa H., Ong P., Sechtem U., Shimokawa H., Merz C.N.B., on behalf of the Coronary Vasomotion Disorders International Study Group (COVADIS) The Who, What, Why, When, How and Where of Vasospastic Angina. Circ. J. 2016;80:289–298. doi: 10.1253/circj.CJ-15-1202. - DOI - PubMed
    1. Ford T.J., Corcoran D., Berry C. Stable coronary syndromes: Pathophysiology, diagnostic advances and therapeutic need. Heart. 2017;104:284–292. doi: 10.1136/heartjnl-2017-311446. - DOI - PMC - PubMed
    1. Igarashi Y., Tamura Y., Suzuki K., Tanabe Y., Yamaguchi T., Fujita T., Yamazoe M., Aizawa Y., Shibata A. Coronary artery spasm is a major cause of sudden cardiac arrest in survivors without underlying heart disease. Coron. Artery Dis. 1993;4:177–186. doi: 10.1097/00019501-199302000-00008. - DOI - PubMed
    1. Abdu F.A., Mohammed A.-Q., Liu L., Xu Y., Che W. Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position. Cardiology. 2020;145:543–552. doi: 10.1159/000509100. - DOI - PubMed
    1. Igarashi Y., Tamura Y., Tanabe Y., Fujita T., Yamazoe M., Shibata A. Angina-linked syncope and lack of calcium antagonist therapy predict cardiac arrest before definitive diagnosis of vasospastic angina. Coron. Artery Dis. 1994;5:881–887. - PubMed

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