Abstract
The diagnostic and prognostic role of nitroglycerin-induced dilation (NID) combined with ergonovine provocation test in patients with suspected VSA patients is not clear. A total of 438 consecutive patients who underwent the ergonovine provocation test for the diagnosis of vasospastic angina (VSA) were enrolled. Patients with VSA (n = 52) had a significantly greater coronary response to ergonovine (− 84.3 ± 10.5% vs. − 38.4 ± 17.9%, p < 0.001) and NID (26.3 ± 31.0% vs. 12.5 ± 19.0%, p < 0.001) than non-VSA patients. However, positive NID (more than 13.8% dilation, n = 170) showed a poor accuracy (AUC 0.64 [95% CI: 0.56–0.73], p = 0.001, sensitivity 60.4%, specificity 61.3%) for the diagnosis of VSA by ergonovine provocation test. Major adverse cardiovascular events (MACE) occurred more frequently in the VSA group than in the non-VSA group (9.6% vs. 2.2%, p = 0.006). In addition, the positive NID group showed a lower rate of MACE than the negative NID group (1.2% vs. 4.3%, p = 0.021). Interestingly, the group of VSA with negative NID had poor prognosis than any other combinations (Log-rank, p < 0.0001). Although NID had a limited role in the detection of VSA defined by ergonovine provocation test, NID combined with the ergonovine provocation test has an additive prognostic role in the clinical outcomes in patients with suspected VSA.
Highlights
The diagnostic and prognostic role of nitroglycerin-induced dilation (NID) combined with ergonovine provocation test in patients with suspected vasospastic angina (VSA) patients is not clear
The frequency of atypical chest pain as an indication of provocation test was significantly lower in the positive NID group than in the negative NID group (7.1% vs. 15.0%, p = 0.014), but other indications did not differ significantly between the two groups
According to receiver operating characteristic (ROC) curve analysis, the ideal cut-off value of NID for the diagnosis of VSA by ergonovine provocation test was more than 13.8% of diameter increase after IC nitroglycerin infusion
Summary
The diagnostic and prognostic role of nitroglycerin-induced dilation (NID) combined with ergonovine provocation test in patients with suspected VSA patients is not clear. NID had a limited role in the detection of VSA defined by ergonovine provocation test, NID combined with the ergonovine provocation test has an additive prognostic role in the clinical outcomes in patients with suspected VSA. Abbreviations ACS Acute coronary syndrome CAG Coronary angiography CCBs Calcium channel blockers IC Intracoronary MACE Major adverse cardiovascular event NID Nitroglycerin induced dilation ROC Receiver operating characteristic VSA Vasospastic angina. The role of NID and combined with ergonovine provocation test in the diagnosis and prognosis in patients with suspected vasospastic angina is not Scientific Reports | (2021) 11:23834. We tested the diagnostic and prognostic role of NID combined with the ergonovine provocation test in patients with suspected VSA patients
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