Acetylcholine Rechallenge Helps Sort Types of Coronary Spasm
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Acetylcholine (ACh) rechallenge may be a novel method to improve detection of coexisting coronary spasm endotypes, and at the same time, assess the treatment response to nitrate-based therapies, a new study suggests. ACh rechallenge could pave the way from trial and error to tailored therapies in patients with coronary spasm
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@jac A total of 95 patients with coronary spasm underwent ACh rechallenge, which consisted of repeated ACh provocation 3 minutes after intracoronary nitroglycerin administration using the same dose that previously induced spasm. During initial ACh provocation, 55 patients (58%) had isolated microvascular spasm and 40 patients (42%) had isolated epicardial spasm (78% diffuse, 22% focal). ACh rechallenge, however, revealed coexisting microvascular spasm in 48% of patients with epicardial spasm (19 of 40).