{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T02:28:57Z","timestamp":1789957737256,"version":"4.0.1"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Intracoronary provocation testing with acetylcholine (ACh) is helpful to diagnose and risk\u2010stratify patients with ischemia with nonobstructed coronary arteries (NOCA) and myocardial infarction with NOCA. This study explored potential sex\u2010related disparities on the prognostic significance of ACh provocative testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Consecutive patients with ischemia with NOCA and those with myocardial infarction with NOCA who underwent ACh provocation testing were enrolled. The primary end point was the incidence of major adverse cardiovascular and cerebrovascular events at follow\u2010up. Co\u2010primary end points were angina recurrence and quality of life assessed by 12\u2010month Seattle Angina Questionnaire (SAQ) summary score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A total of 519 patients (mean age, 61.4\u00b112.1\u2009years; 275 [53.0%] women and 244 [47%] men) were enrolled: 346 (66.7%) with ischemia with NOCA and 173 (33.3%) with myocardial infarction with NOCA. A positive ACh test was observed in 274 (52.8%) patients, with a lower prevalence of epicardial spasm (82 [56.2%] versus 106 [82.8%]) and a higher prevalence of microvascular spasm (64 [43.8%] versus 22 [17.2%]) in women compared with men (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &gt;0.001). After a median 22\u2010month follow\u2010up, major adverse cardiovascular and cerebrovascular events occurred in 53 (10.2%) patients, without significant sex differences (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &gt;0.05). Men with a positive ACh test had a significantly higher rate of major adverse cardiovascular and cerebrovascular events (22 [17.2%] versus 5 [4.3%],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.002) compared with those with a negative test; no difference was observed in women (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &gt;0.05) (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      for interaction=0.003). Women with a positive test experienced a higher rate of angina recurrence (61 [41.8%] versus 32 [24.8%],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.005) and a lower SAQ summary score (82 [interquartile range, 72\u201390] versus 86 [interquartile range, 78\u2013100],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) compared with those with a negative result; no difference was observed in men (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &gt;0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">This study revealed the importance of recognizing sex\u2010specific differences in the prognostic value of ACh testing for proper management of coronary vasomotor disorders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.037942","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T06:13:53Z","timestamp":1740464033000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Sex\u2010Related Differences in the Prognostic Role of Acetylcholine Provocation Testing"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0559-2626","authenticated-orcid":false,"given":"Riccardo","family":"Rinaldi","sequence":"first","affiliation":[{"name":"Catholic University of the Sacred Heart","place":["Rome, Italy"]},{"name":"Infermi Hospital","place":["Rimini, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6602-971X","authenticated-orcid":false,"given":"Michele","family":"Russo","sequence":"additional","affiliation":[{"name":"S. 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