Safety and predictors of a positive result of intracoronary ergonovine testing in patients with ischemic heart disease without hemodynamically significant coronary artery stenosis in Taiwan

Background: No information is available regarding the safety of intracoronary ergonovine provocation testing and the associated predictors in patients with suspected ischemic heart disease without hemodynamically significant coronary artery stenosis (CAS) in Taiwan. Methods: Patients who underwent cardiac catheterization for suspected ischemic heart disease and were found to have no hemodynamically significant CAS between January 2000 and December 2004 were enrolled. Provocation testing for coronary vasospasm was undertaken by administering a step-wise dose of intracoronary ergonovine. Coronary vasospasm was defined as a reduction in luminal diameter 70% during the provocation testing which was associated with angina and/or ST-depressive or elevated changes. Results: A total of 454 patients, including 193 with no hemodynamically significant CAS and no coronary vasospasm (control group) and 261 with coronary vasospasm without hemodynamically significant CAS (vasospasm group), were included in the analysis. The incidence of provoked coronary vasospasm was 57%. Patients with coronary vasospasm were more likely to be older, men, current smokers and to have a lower body mass index. The most significant independent predictor of coronary vasospasm was current smoker (odds ratio: 2.796, p < 0.001). No myocardial infarction or death was noted during intracoronary ergonovine testing. Ventricular fibrillation occurred during provocation testing in 3 patients (0.66%), of whom 2 required electric cardioversion and 1 had spontaneous recovery without sequelae. Conclusion: Intracoronary ergonovine provocation testing was not a risky intervention procedure for the diagnosis of coronary vasospasm. Current smoking was the most significant independent predictor of coronary vasospasm.