This protocol addresses vasospastic angina with confirmed epicardial (macrovascular) coronary spasm on acetylcholine provocation testing. The positive test is characterised by anginal symptoms, ischaemic ECG changes, and an angiographic coronary lumen reduction of 90% or more.
Nitrates were used in the prior treatment line. The intended goal — prevention of recurrent vasospastic episodes — was not achieved. This protocol represents the next step after that failure.
A combinatorial vasodilator agent may offer an effective alternative in this setting. The complete structured regimen — including agent selection, sequencing, and clinical monitoring — is available via the full protocol.
DOI: 10.1093/eurheartj/ehae177
The test is considered positive for macrovascular spasm if symptoms occur, accompanied by ischaemic ECG changes and an angiographic ≥90% reduction of the coronary lumen.
Nicorandil, a combinatorial vasodilator agent acting via nitrate- and potassium-channel activation, may be an effective alternative, although side effects are frequent.
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