Serious cardiac complications in coronary spasm provocation tests using acetylcholine or ergonovine: analysis of 21 512 patients from the diagnosis procedure combination database in Japan.

ABSTRACT: BACKGROUND:Previous studies on complications with coronary spasm provocation tests were based on small sample sizes or were limited to high-volume centers. The risk of provocation tests using acetylcholine (ACH) or ergonovine (ER) remains to be fully examined by a large-scale multicenter study. HYPOTHESIS:ACH provocation tests are associated with a higher rate of serious cardiac complications than ER tests. METHODS:Using the Diagnosis Procedure Combination database in Japan, we identified patients aged ?20 years who underwent a pharmacological provocation test during coronary angiography. We assessed the composite outcome of cardiac complications requiring urgent procedures (defibrillation, chest compression, intra-aortic balloon pumping, or extracorporeal membrane oxygenation) or death on the day of the provocation test, and compared the outcome between ACH and ER tests. RESULTS:Of 21?512 eligible patients in 602 hospitals, 10?628 (49.4%) underwent an ACH test and 10?884 (50.6%) underwent an ER test. The composite outcome occurred in 141 (0.7%) patients. The ACH group was significantly more likely to have the composite outcome than the ER group (0.9% vs 0.4%, P < 0.001). The propensity-score analyses showed consistent results (propensity score-matched, 0.9% vs 0.4%, P = 0.003; inverse probability-weighted, 0.8% vs 0.4%, P < 0.001). In a multivariable logistic regression analysis, ACH tests were significantly associated with a higher rate of the composite outcome than ER tests (odds ratio: 1.75, 95% confidence interval: 1.13-2.69, P = 0.011). CONCLUSIONS:This retrospective cohort study suggested that ACH tests were associated with a higher rate of cardiac complications than ER tests.

SUBMITTER: Isogai T 

PROVIDER: S-EPMC6711001 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature