{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:38Z","timestamp":1753876238946,"version":"3.41.2"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The intracoronary acetylcholine (ACh) and ergonovine (ER) test is employed as a pharmacological spasm provocation test. ACh causes vasoconstriction in patients with coronary endothelial dysfunction such as coronary atherosclerosis, while ER induces coronary vasoconstriction through the activation of coronary smooth muscle.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>An 84-year-old Japanese man was admitted to our hospital due to resting angina and syncope. Computed tomography coronary angiography (CTCAG) revealed severe proximal left anterior descending (LAD) coronary artery stenosis, but hybrid images of CTCAG and thallium-adenosine myocardial scintigraphy revealed no ischaemia. During syncope, inverted T waves on V5, V6 leads were recognized. After coronary arteriography, mild atherosclerotic stenosis (50%) was found at the proximal LAD artery, and we administered intracoronary ER 104 \u00b5g and 80 \u00b5g into the left and right coronary arteries because of suspected coronary spasm. However, no provoked spasm was obtained in either vessel. We administered 20, 50, and 100 \u00b5g intracoronary ACh into the left coronary artery (LCA) for 30 s without a pacemaker, because neither bradycardia nor cardiac arrest has occurred. Diffuse distal spasm was provoked after the administration of 100 \u00b5g ACh and the patient complained of typical chest pain and prodrome before syncope. The patient was diagnosed with coronary spastic angina by the ACh test but not the ER test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Different coronary responses between ACh and ER were observed in this case. Intracoronary ACh testing without a pacemaker may be one option in the LCA if no bradycardia or arrest occurs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab162","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T23:59:40Z","timestamp":1634774380000},"source":"Crossref","is-referenced-by-count":1,"title":["A case report: intracoronary acetylcholine testing without a pacemaker may be one option in the left coronary artery"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-6331","authenticated-orcid":false,"given":"Shozo","family":"Sueda","sequence":"first","affiliation":[{"name":"Department of Cardiology, Ehime Prefectural Niihama Hospital, Hongou 3 choume 1-1, Niihama City, Ehime Prefecture, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0203-4354","authenticated-orcid":false,"given":"Tomoki","family":"Sakaue","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Yawatahama City General Hospital, Ohira 1-638, Yawatahama City, Ehime Prefecture, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,10,20]]},"reference":[{"key":"2021102005144489000_ytab162-B1","first-page":"2949","article-title":"2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the Management of Stable Coronary Artery Disease of the European Society of Cardiology [published correction appears in Eur Heart J 2014; 35: 2260-2261]","volume":"34","author":"Montalescot","year":"2013","journal-title":"Eur Heart J"},{"key":"2021102005144489000_ytab162-B2","first-page":"e663","article-title":"2012 ACCF\/AHA focused update incorporated into the ACCF\/AHA 2007 guidelines for the management of patients with unstable angina\/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2013; 127: e863-e864]","volume":"127","author":"Anderson","year":"2012","journal-title":"Circulation"},{"key":"2021102005144489000_ytab162-B3","first-page":"2565","article-title":"International standardization of diagnostic criteria for vasospastic angina","volume":"38","author":"Beltrame","year":"2017","journal-title":"Eur Heart J"},{"key":"2021102005144489000_ytab162-B4","doi-asserted-by":"crossref","first-page":"2779","DOI":"10.1253\/circj.CJ-66-0098","article-title":"Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary spastic angina) (JCS 2013)","volume":"78","author":"JCS joint working group","year":"2014","journal-title":"Circ J"},{"key":"2021102005144489000_ytab162-B5","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1007\/s00380-014-0614-4","article-title":"Gender differences in sensitivity of acetylcholine and ergonovine to coronary spasm provocation test","volume":"31","author":"Sueda","year":"2016","journal-title":"Heart Vessels"},{"key":"2021102005144489000_ytab162-B6","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/00019501-200412000-00006","article-title":"Clinical impact of selective spasm provocation tests: comparisons between acetylcholine and ergonovine in 1508 examinations","volume":"15","author":"Sueda","year":"2004","journal-title":"Coron Artery Dis"},{"key":"2021102005144489000_ytab162-B7","doi-asserted-by":"crossref","first-page":"e000227","DOI":"10.1161\/JAHA.113.000227","article-title":"Coronary vasomotor response to intracoronary acetylcholine injection, clinical features, and long-term prognosis in 873 consecutive patients with coronary spasm: analysis of a single-center study over 20 years","volume":"2","author":"Sato","year":"2013","journal-title":"J Am Heart Assoc"},{"key":"2021102005144489000_ytab162-B8","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.jacc.2011.11.015","article-title":"High prevalence of a pathological reponse to acetylcholine testing in patients with stable angina pectoris and unobstructed coronary arteries: the ACOVA study","volume":"59","author":"Ong","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"2021102005144489000_ytab162-B9","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jcct.2016.04.005","article-title":"CAD-RADS\u2122: coronary artery disease\u2014reporting and data system. 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