Heart and Vessels

, Volume 33, Issue 8, pp 846–852 | Cite as

Feasibility and safety of outpatient cardiac catheterization with intracoronary acetylcholine provocation test

  • Yuichi Saito
  • Hideki Kitahara
  • Toshihiro Shoji
  • Satoshi Tokimasa
  • Takashi Nakayama
  • Kazumasa Sugimoto
  • Yoshihide Fujimoto
  • Yoshio Kobayashi
Original Article


Intracoronary acetylcholine (ACh) provocation test is useful to diagnose vasospastic angina. Although outpatient coronary angiography has been widely performed in current clinical settings, the feasibility and safety of ACh provocation test in outpatient services are unclear. A total of 323 patients, who electively underwent ACh provocation test in hospitalization and outpatient services, were included. Coronary angiography was performed after insertion of a temporary pacing electrode in the right ventricle. The positive diagnosis of intracoronary ACh provocation test was defined as total or subtotal coronary artery narrowing accompanied by chest pain and/or ischemic electrocardiographic changes. Cardiac complications defined as composite of death, ventricular fibrillation or sustained ventricular tachycardia, myocardial infarction, cardiogenic shock, and cardiac tamponade, were evaluated. There were 201 patients (62%) in the hospitalization group and 122 patients (38%) in the outpatient group. The incidence of positive ACh provocation test was similar between the 2 groups (47 vs. 54%, p = 0.21). Coronary angiography in the outpatient group was performed through the radial artery, mostly (98%) with a 4 F sheath. Venous access site was not significantly different between the 2 groups, and the sheath size was 5 F in all cases. There were 2 cases (1.0%) of cardiac complications in the hospitalization group, whereas 1 case (0.8%), which led to unexpected hospitalization, occurred in the outpatient group. In conclusion, intracoronary ACh provocation test for the diagnosis of vasospastic angina in outpatient services was feasible and safe in selected patients.


Vasospastic angina Acetylcholine provocation test Outpatient services 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Yuichi Saito
    • 1
  • Hideki Kitahara
    • 1
  • Toshihiro Shoji
    • 1
  • Satoshi Tokimasa
    • 1
  • Takashi Nakayama
    • 1
  • Kazumasa Sugimoto
    • 1
  • Yoshihide Fujimoto
    • 1
  • Yoshio Kobayashi
    • 1
  1. 1.Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan

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