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

BackgroundPrevious 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. HypothesisACH provocation tests are associated with a higher rate of serious cardiac complications than ER tests. MethodsUsing 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. ResultsOf 21512 eligible patients in 602 hospitals, 10628 (49.4%) underwent an ACH test and 10884 (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). ConclusionsThis retrospective cohort study suggested that ACH tests were associated with a higher rate of cardiac complications than ER tests.