Provocative testing for coronary reactivity and spasm

J Am Coll Cardiol. 2014 Jan 21;63(2):103-9. doi: 10.1016/j.jacc.2013.10.038. Epub 2013 Nov 6.


Coronary spasm is an important and often overlooked etiology of chest pain. Although coronary spasm, or Prinzmetal's angina, has been thought of as benign, contemporary studies have shown serious associated adverse outcomes, including acute coronary syndrome, arrhythmia, and death. Definitive diagnosis of coronary spasm can at times be difficult, given the transience of symptoms. Numerous agents have been historically described for provocative testing. We provide a review of published data for the role of provocation testing in the diagnosis of coronary spasm.

Keywords: ACH; CFR; CS; ER; IC; IV; MI; Prinzmetal's angina; SCA; acetylcholine; coronary flow reserve; coronary spasm; ergonovine; intracoronary; intravenous; myocardial infarction; provocation testing; sudden cardiac arrest.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acetylcholine
  • Chest Pain / diagnosis
  • Chest Pain / etiology*
  • Coronary Angiography*
  • Coronary Vasospasm / complications
  • Coronary Vasospasm / diagnosis*
  • Diagnosis, Differential
  • Electrocardiography*
  • Exercise Test / methods*
  • Humans
  • Vasodilator Agents


  • Vasodilator Agents
  • Acetylcholine