Is there a role for provocation testing to diagnose coronary artery spasm?

Coronary spasm provocation testing: still useful?

“…High rates of a positive provocation test are observed in Asian populations [2]. The ergonovine challenge is more likely to be positive in patients with rest rather than exertional angina pectoris [3].…”

“…Nonetheless, given rare occurrence of serious complications including death, it is suggested that where there is moderate clinical suspicion of coronary vasospasm, medical therapy (oral nitrates / calcium channel blockers) be used as an initial approach. In refractory cases, provocation testing may be applied for targeting possible stent sites -an approach that can sometimes successfully reduce the propensity towards spasm at the treated site [2].…”

Transient ST-Segment Elevation due to Iatrogenic Hyperthyroidism in a Patient with Normal Coronary Arteries

“…In the present patient, the clinical course highly favored coronary vasospasm so that provocation test was not considered and medical treatment was started. The role of provocation test in the diagnosis of coronary vasospasm is controversial (16). Patients with a high clinical suspicion of coronary vasospasm can be started on medical treatment without provocation test.…”

ST‐segment Elevation in Lead Augmented Vector Right may also be Caused by Diffuse Left Main Coronary Artery Vasospasm Without Fixed Stenosis

“…Widespread use of these tests in patients with undiagnosed chest pain syndromes should not be recommended currently. 12 Therefore, we did not perform provocative testing. …”