Pharmacological coronary spasm provocative testing in clinical practice: A French Coronary Atheroma and Interventional Cardiology Group (GACI) position paper.

[Display omitted] • VSA is common and is involved in many clinical scenarios. • These include chronic and acute coronary syndromes, SCD, arrhythmia and syncope. • VSA is underdiagnosed and provocative tests are rarely performed. • A lack of uniform protocol decreases the use and performance of provocative tests. • This accounts for VSA underestimation. • This GACI position paper gives clear indications for provocative tests. • The paper also addresses testing conditions, drug protocols and positivity criteria. Vasospastic angina, also described as Prinzmetal angina, was first described as a variant form of angina at rest with transient ST-segment elevation; it is common and present in many clinical scenarios, including chronic and acute coronary syndromes, sudden cardiac death, arrhythmia and syncope. However, vasospastic angina remains underdiagnosed, and provocative tests are rarely performed. The gold-standard diagnostic approach uses invasive coronary angiography to induce coronary spasm using ergonovine, methylergonovine or acetylcholine as provocative stimuli. The lack of uniform protocol decreases the use and performance of these tests, accounting for vasospastic angina underestimation. This position paper from the French Coronary Atheroma and Interventional Cardiology Group (GACI) aims to review the indications for provocative tests, the testing conditions, drug protocols and positivity criteria. [ABSTRACT FROM AUTHOR]