Background and aims: Acetylcholine (ACh) provocation testing can detect vasomotor disorders in patients with ischemia and non-obstructed coronary arteries (INOCA) or myocardial infarction and non-obstructed coronary arteries (MINOCA). We aimed to derive and validate a simple risk score to predict a positive ACh test response. Methods: We prospectively enrolled consecutive INOCA and MINOCA patients undergoing ACh provocation testing. Patients were split in two cohorts (derivation and validation) according to time of enrolment. The score was derived in 386 patients (derivation cohort) and then validated in 165 patients (validation cohort). Results: 551 patients were enrolled, 371 (67.3%) INOCA and 180 (32.7%) MINOCA. ACh test was positive in 288 (52.3%) patients. MINOCA, myocardial bridge (MB), C-reactive protein (CRP) and dyslipidaemia were independent predictors of a positive ACh test in the derivation cohort. The ABCD (Acute presentation, Bridge, CRP, Dyslipidaemia) score was derived: 2 points were assigned to MINOCA, 3 to MB, 1 to elevated CRP and 1 to dyslipidaemia. The ABCD score accurately identified patients with a positive ACh test response with an AUC of 0.703 (CI 95% 0.652–0.754,p < 0.001) in the derivation cohort, and 0.705 (CI 95% 0.626–0.784, p < 0.001) in the validation cohort. In the whole population, an ABCD score ≥4 portended 94.3% risk of a positive ACh test and all patients with an ABCD score ≥6 presented a positive test. Conclusions: The ABCD score could avoid the need of ACh provocation testing in patients with a high score, reducing procedural risks, time, and costs, and allowing the implementation of a tailored treatment strategy. These results are hypothesis generating and further research involving larger cohorts and multicentre trials is needed to validate and refine the ABCD score.

Predicting the response to acetylcholine in ischemia or infarction with non-obstructive coronary arteries: The ABCD score / Rinaldi, R.; Colucci, M.; Torre, I.; Ausiello, D.; Bonanni, A.; Basile, M.; Salzillo, C.; Sanna, T.; Liuzzo, G.; Leone, A. M.; Burzotta, F.; Trani, C.; Lanza, G. A.; Niccoli, G.; Crea, F.; Montone, R. A.. - In: ATHEROSCLEROSIS. - ISSN 0021-9150. - 391:(2024). [10.1016/j.atherosclerosis.2024.117503]

Predicting the response to acetylcholine in ischemia or infarction with non-obstructive coronary arteries: The ABCD score

Niccoli G.;
2024-01-01

Abstract

Background and aims: Acetylcholine (ACh) provocation testing can detect vasomotor disorders in patients with ischemia and non-obstructed coronary arteries (INOCA) or myocardial infarction and non-obstructed coronary arteries (MINOCA). We aimed to derive and validate a simple risk score to predict a positive ACh test response. Methods: We prospectively enrolled consecutive INOCA and MINOCA patients undergoing ACh provocation testing. Patients were split in two cohorts (derivation and validation) according to time of enrolment. The score was derived in 386 patients (derivation cohort) and then validated in 165 patients (validation cohort). Results: 551 patients were enrolled, 371 (67.3%) INOCA and 180 (32.7%) MINOCA. ACh test was positive in 288 (52.3%) patients. MINOCA, myocardial bridge (MB), C-reactive protein (CRP) and dyslipidaemia were independent predictors of a positive ACh test in the derivation cohort. The ABCD (Acute presentation, Bridge, CRP, Dyslipidaemia) score was derived: 2 points were assigned to MINOCA, 3 to MB, 1 to elevated CRP and 1 to dyslipidaemia. The ABCD score accurately identified patients with a positive ACh test response with an AUC of 0.703 (CI 95% 0.652–0.754,p < 0.001) in the derivation cohort, and 0.705 (CI 95% 0.626–0.784, p < 0.001) in the validation cohort. In the whole population, an ABCD score ≥4 portended 94.3% risk of a positive ACh test and all patients with an ABCD score ≥6 presented a positive test. Conclusions: The ABCD score could avoid the need of ACh provocation testing in patients with a high score, reducing procedural risks, time, and costs, and allowing the implementation of a tailored treatment strategy. These results are hypothesis generating and further research involving larger cohorts and multicentre trials is needed to validate and refine the ABCD score.
2024
Predicting the response to acetylcholine in ischemia or infarction with non-obstructive coronary arteries: The ABCD score / Rinaldi, R.; Colucci, M.; Torre, I.; Ausiello, D.; Bonanni, A.; Basile, M.; Salzillo, C.; Sanna, T.; Liuzzo, G.; Leone, A. M.; Burzotta, F.; Trani, C.; Lanza, G. A.; Niccoli, G.; Crea, F.; Montone, R. A.. - In: ATHEROSCLEROSIS. - ISSN 0021-9150. - 391:(2024). [10.1016/j.atherosclerosis.2024.117503]
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2985394
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 3
  • ???jsp.display-item.citation.isi??? 1
social impact