We analyzed the results of 61 consecutive outpatient
ergonovine provocation tests to determine the safety and efficacy of such outpatient testing for detecting
coronary artery spasm (CAS). Criteria for outpatient testing included: clinical history suggestive of variant angina, noncritical
coronary artery disease documented by coronary arteriography, normal exercise treadmill test, no symptomatic arrhythmias, and no history of recent
myocardial infarction. All antianginal medications were tapered and stopped.
Ergonovine maleate was given as a bolus at 3-minute intervals in consecutive doses of 0.05, 0.10, and 0.25 mg. A positive test was defined as
chest pain accompanied by greater than 0.1 mV ST segment elevation of 12-lead ECG. If
pain and ST-segment elevation occurred, intravenous and sublingual
nitroglycerin were immediately administered for relief of
myocardial ischemia. Of the 61 patients studied, 10 had positive tests; there were no complications. Follow-up the 51 patients with negative studies has not revealed cardiac etiology for their
chest pain. We conclude that outpatient
ergonovine testing is a safe and accurate diagnostic test for identifying CAS in a highly selected population of patients with possible variant angina when performed under carefully controlled conditions.