Heart and Vessels

, Volume 34, Issue 5, pp 745–754 | Cite as

Differential incidence and morphology of provoked spasm between intracoronary acetylcholine and ergonovine testing: recommendation of supplementary use

  • Shozo SuedaEmail author
  • Kaori Fujimoto
  • Yasuhiro Sasaki
  • Tomoki Sakaue
  • Toyofumi Yoshii
  • Hirokazu Habara
  • Hiroaki Kohno
Original Article


When cardiologists diagnose patients with coronary spastic angina, Japanese Circulation Society (JCS) guidelines recommend the intracoronary injection of acetylcholine (ACh) and ergonovine (ER) as class I. However, the pharmacological difference between ACh and ER is controversial in the clinic. We performed both ACh and ER tests in the same 528 patients during 26 years. We investigated the provoked spasm configuration, spasm site, and clinical characteristics of provoked spasm between ACh and ER, retrospectively. We defined positive spasm as ≥90% luminal narrowing. Provoked positive spasm was observed in 161 right coronary arteries (RCA) including 83 ACh just positive, 35 ER just positive, and 43 both positive. In contrast, positive spasm was documented in 172 left coronary arteries (LCA) including 94 ACh just positive, 28 ER just positive, and 50 both positive. ACh provoked spasm more distally and diffusely, while ER induced spasm more proximally and totally or focally in the RCA. In the LCA, ACh provoked spasm more proximally, whereas ER induced spasm more distally. ER testing after the negative ACh tests of RCA and LCA documented new positive spasms in 10.3% (35/340) and 7.4% (28/376), respectively. Coronary artery trees may each have a sensitive receptor on each segment. We recommend the supplementary use of ACh and ER to document coronary artery spasm in the cardiac catheterization laboratory.


Positive spasm Acetylcholine Ergonovine Supplementary use 



We acknowledge the helpful comments of Professor Osamu Yamaguchi, MD, Professor Yuji Shigematsu, MD, Professor Mareomi Hamada, MD, Professor Jitsuo Higaki, MD and Professor Kunio Hiwada, MD.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Shozo Sueda
    • 1
    Email author
  • Kaori Fujimoto
    • 1
  • Yasuhiro Sasaki
    • 1
  • Tomoki Sakaue
    • 1
  • Toyofumi Yoshii
    • 1
  • Hirokazu Habara
    • 1
  • Hiroaki Kohno
    • 2
  1. 1.Department of CardiologyEhime Niihama Prefectural HospitalNiihama CityJapan
  2. 2.Department of CardiologyTsukazaki HospitalHimejiJapan

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