Ultra-long acting calcium channel blockers may decrease accuracy of the acetylcholine provocation test.
Int J Cardiol
; 236: 71-75, 2017 Jun 01.
Article
em En
| MEDLINE
| ID: mdl-28268085
ABSTRACT
BACKGROUND:
When drug-induced coronary spasm provocation tests are performed, a washout period of >48h for calcium channel blockers (CCBs) is uniformly recommended. However, each CCB has a distinct half-life, and little is known about the influence of prior oral administration of CCBs on acetylcholine provocation test to evaluate coronary vasomotor reaction. METHODS ANDRESULTS:
We examined 245 consecutive patients with suspected vasospastic angina who had undergone acetylcholine provocation test. Of those patients, 29 patients had been on amlodipine, an ultra-long term acting CCB (group A), 34 on other CCBs (group O), and 182 patients on no CCB (group N). After CCBs had been withheld > 48h, we performed acetylcholine provocation, which resulted in 152 positive, 36 intermediate, and 57 negative reactions. We evaluated coronary artery tone calculated as follows (luminal diameter after nitrate-baseline luminal diameter)÷(luminal diameter after nitrate)×100 (%). In group A patients, coronary artery tone was lower (A9.1±6.9% vs. O11.7±8.3% vs. N12.1±8.5%, p=0.0011) and the positive rate of acetylcholine provocation test was lower than group O and group N (A41% vs. O68% vs. N64%, p=0.047). Multivariate logistic analysis showed that taking amlodipine until 2days before acetylcholine provocation test was a significant inverse predictor for acetylcholine-provoked coronary spasm (odds ratio 0.327; 95% confidence interval 0.125-0.858, p=0.023).CONCLUSIONS:
Residual vasodilatory effects of ultra-long acting CCB may decrease coronary artery tone and the vasoconstrictive reaction to acetylcholine suggesting that a 2-day pre-test drug holiday may not be long enough.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Bloqueadores dos Canais de Cálcio
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Acetilcolina
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Vasoespasmo Coronário
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Vasos Coronários
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Suspensão de Tratamento
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Angina Pectoris Variante
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article