Supersensitivity of coronary arteries in variant angina to spasm induced by intracoronary acetylcholine

      This paper is only available as a PDF. To read, Please Download here.


      Acetylcholine (20 to 100 μg) was infused directly into coronary arteries in 10 patients with variant angina (group A), 13 subjects without coronary artery disease (group B) and 8 patients with significant organic coronary artery stenosis (≥50%) but without variant angina (group C) during coronary arteriography, to clarify the action of this agent on coronary arteries. Temporary pacing was performed at a demand heart rate of 40 beats/min white bradyarrhythmia developed. Coronary arteriography after administration of acetyleholine showed coronary vasoconstriction in all 10 patients (100%) of group A. Angina accompanied by etectrocardiographic ischemic changes in 9 of 10 (90%, 7 ST-segment elevation and 2 depression) was provoked during this test. In the patients of group B, acetylcholine also induced vasoconstriction in 8 of 22 (36%) coronary arterial systems examined, chest pain in 3 (14%) and ST-segment deviation in none (0%). In the patients of group C, acetylcholine induced vasoconstriction in 3 of 9 (33%), chest pain in 2 (22%) and ST-segment depression in 1 (11%). No definite coronary artery dilation induced by acetylcholine was noted. Coronary vasoconstriction (p < 0.05), etectrocardiographic ischemic findings (p < 0.01) and chest pain (p < 0.01) were induced significantly more frequently in group A than in both groups B and group C. No significant difference was found between group B and group C. The coronary arteries in the patients with variant angina seem to be more susceptible to acetylcholine than those of patients without variant angina irrespective of the presence of significant atherosclerosis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wiener L
        • Lasparian H
        • Duca PR
        • Walinsky P
        • Gottlieb RS
        • Hanckel F
        • Brest AN
        Spectrum of coronary arterial spasm. Clinical, angiographic and metabolic experience in 29 cases.
        Am J Cardiol. 1976; 38: 945-955
        • Yasue H
        • Omote S
        • Takizawa A
        • Nagao M
        • Miwa K
        • Tanaka S
        Exertional angina pectoris caused by coronary arterial spasm: effects of various drugs.
        Am J Cardiol. 1979; 43: 647-652
        • Maseri A
        • Pesola A
        • Marzilli M
        • Severi S
        • Parodi O
        • L'Abbate A
        • Ballestra AM
        • Maltinti G
        • De Nes M
        • Biagini A
        Coronary vasospasm in angina pectoris.
        Lancet. 1977; 1: 713-717
        • Oliva PB
        • Breckinridge JC
        Arteriographic evidence of coronary arterial spasm in acute myocardial infarction.
        Circulation. 1977; 56: 366-374
        • Roberts WC
        • Curry RC
        • Isner JM
        • Waller BF
        • McManus BM
        • Mariani-Constantini R
        • Ross AM
        Sudden death in Prinzmetal's angina with coronary spasm documented by angiography. Analysis of three necropsy patients.
        Am J Cardiol. 1982; 50: 203-210
        • Oliva PB
        • Potts DE
        • Pluss RG
        Coronary arterial spasm in Prinzmetal's angina: documentation by coronary arteriography.
        N Engl J Med. 1973; 288: 745-751
        • Ginsburg R
        • Bristow MR
        • Kantrowitz N
        • Baim DS
        • Harrison DC
        Histamine provocation of clinical coronary arterial spasm: implication concerning pathogenesis of variant angina pectoris.
        Am Heart J. 1981; 102: 819-822
        • Henry PD
        • Yokoyama M
        Supersensitivity of atherosclerotic rabbit aorta to ergonovine.
        J Clin Invest. 1980; 66: 306-313
        • Tada M
        • Kuzuya T
        • Inoue M
        • Kodama K
        • Mishima M
        • Yamada M
        • Inui M
        • Abe H
        Elevation of thromboxane b2 levels in patients with classical and variant angina pectoris.
        Circulation. 1981; 64: 1107-1115
        • Schroeder JS
        • Bolen JL
        • Quint RA
        Provocation of coronary spasm with ergonovine maleate: new test with results in 57 patients undergoing coronary arteriography.
        Am J Cardiol. 1977; 40: 487-491
        • Yasue H
        • Nagao M
        • Omote S
        • Takizawa A
        • Miwa K
        • Tanaka S
        Coronary arterial spasm and Prinzmetal's variant form of angina induced by hyperventilation and Tris-buffer infusion.
        Circulation. 1978; 58: 56-62
        • Yasue H
        • Touyama M
        • Shimamoto M
        • Kato H
        • Tanaka S
        • Akiyama F
        Role of autonomic nervous system in the pathogenesis of Prinzmetal's variant form of angina.
        Circulation. 1974; 50: 534-539
        • Yasue H
        • Touyama M
        • Kato H
        • Tanaka S
        • Akiyama F
        Prinzmetal's variant form of angina as a manifestation of alpha-adrenergic receptor-mediated coronary artery spasm: documentation by coronary arteriography.
        Am Heart J. 1976; 91: 148-155
        • Endo M
        • Hirosawa K
        • Kaneko N
        • Hase K
        • Inoue Y
        • Konno S
        Prinzmetal's variant angina: coronary arteriogram and left ventriculogram during angina attack induced by methacholine.
        N Engl J Med. 1976; 294: 252-255
        • Yasue H
        • Horio Y
        • Nakamura N
        • Fujii H
        • Imoto N
        • Sonoda R
        • Kugiyama K
        • Obata K
        • Morikami Y
        • Kimura T
        Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm.
        Circulation. 1986; 74: 955-963
        • Bruce RA
        • Horsten TR
        Exercise stress testing in evaluation of patients with ischemic heart disease.
        Prog Cardiovasc Dis. 1969; 11: 371-390
      1. American Heart Association Committee Report. A reporting system on patients evaluated for coronary artery disease.
        Circulation. 1975; 51: 5-40
        • Horio Y
        • Yasue H
        • Rokutanda M
        • Nakamura N
        • Ogawa H
        • Takaoka K
        • Matsuyama K
        • Kimura T
        Effects of intracoronary injection of acetylcholine on coronary artery diameter.
        Am J Cardiol. 1986; 57: 984-989
        • Ludmer PL
        • Selwyn AP
        • Shook TL
        • Wayne RR
        • Mudge GH
        • Alexander RW
        • Ganz P
        Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries.
        N Engl J Med. 1986; 315: 1046-1051
        • Levy MN
        • Martin PJ
        Neural control of the heart.
        in: The Cardiovascular System. 2nd ed. Handbook of Physiology. vol. 1. American Physiological Society, Bethesda, MD1979: 581-620
        • Ginsburg R
        The isolated human epicardial coronary artery.
        Am J Cardiol. 1983; 52: 61A-66A
        • Toda N
        Isolated human coronary arteries in response to vasoconstrictor substances.
        Am J Physiol. 1983; 245: H937-H941
        • Ginsburg R
        • Bristow MR
        • Davis K
        Receptor mechanism in the human epicardial coronary artery. Heterogenous pharmacological response to histamine and carbachol.
        Circ Res. 1984; 55: 416-421
        • Sinzinger H
        • Feigl W
        • Siberbauer K
        Prostacyclin generation in atherosclerotic arteries.
        Lancet. 1979; 2: 469
        • Furchgott RF
        • Zawadzki JV
        The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine.
        Nature. 1980; 288: 373-376