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Safety Evaluation of Routine Intracoronary Acetylcholine Infusion in Patients Undergoing a First Diagnostic Coronary Angiogram
  1. R. A. Tio,
  2. S. H. J. Monnink,
  3. G. Amoroso,
  4. G. A. J. Jessurun,
  5. N. Veeger,
  6. C. Volkers,
  7. R. Hautvast,
  8. E. S. Tan,
  9. W. H. van Gilst,
  10. A. J. van Boven
  1. From the Department of Cardiology, Thoraxcenter, University Hospital Groningen, Department of Pharmacology, State University Groningen, and Trial Coordinating Center, Thoraxcenter, University Hospital Groningen, The Netherlands.
  1. Address correspondence to: Dr. R.A. Tio, Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. E-mail r.a.tio{at}


Background Recent findings imply prognostic significance of intracoronary acetylcholine infusion for endothelial function testing. We evaluated whether routine use of this test in coronary angiography patients is safe.

Methods Patients undergoing a first diagnostic coronary angiography were selected to receive intracoronary acetylcholine for endothelial function evaluation. The relation between adverse reactions during infusion and risk factors was analyzed with a logistic regression model. Included in the multiple logistic regression model were the variables with a univariate P value < 0.20.

Results Adverse reactions occurred in 16% (49/299) of the patients. This included two life-threatening events caused by occlusive spasm and flow limitation in the left coronary artery. Other adverse events were chest pain (n = 38), AV block or sinus bradycardia (n = 10), dyspnea (n = 3). Adverse reactions were more likely to occur in patients younger than 60 years of age (relative risk, 5.6 [2.2–14.3]).

Conclusion Intracoronary acetylcholine infusion is safe, but may lead to serious adverse reactions. Care should be taken especially in patients younger than 60 years of age. Routine use of acetylcholine infusion can thus only be justified if it has important prognostic significance. This has to be proven further in large prospective studies.

Key Words
  • acetylcholine
  • endothelium
  • coronary artery
  • human
  • spasm
  • adverse reaction
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