Developing a multi-disciplinary program for routine acetylcholine vasoreactivity testing in the cardiac catheterization laboratory Article Swipe
Laurie Tran
,
M Tuite
,
S Michaela Serpa
,
Steffne Kunnirickal
,
Teresa Esposito
,
Steven Pfau
,
SM Tanjil Shah
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1093/eurheartj/ehab724.3038
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1093/eurheartj/ehab724.3038
Background/Introduction Of the patients who are referred for invasive coronary angiography 30–50% are found to have no obstructive coronary artery disease. Current ESC Guidelines for chronic coronary syndromes have a class IIa recommendation for intracoronary provocative testing with acetylcholine in patients with ischemia and no obstructive coronary artery disease (INOCA). However, there is limited guidance for pharmacy and nursing teams for the support of provocative testing in the cardiac catheterization laboratory. Purpose To demonstrate feasibility and safety of acetylcholine vasoreactivity testing in the cardiac catheterization laboratory. Methods The inpatient pharmacy developed an adapted protocol based on available evidence and facilitated a multi-disciplinary operational workflow for the assessment of vasospastic angina. 3mL acetylcholine aliquots of 1mcg/mL, 10 mcg/mL, 25 mcg/mL, 50 mcg/mL, and 100 mcg/mL were prepared by pharmacy following sterile compounding standards. The transition from provider or nursing staff compounding to pharmacy compounding provided quality assurance following United States Pharmacopeia compounding standards for improved sterility and patient safety, especially with a complicated micro-dilution recipe. Pharmacy supported the necessary guidance with optimized clinical decision support in the form of a customized order panel embedded in the electronic health record system and compounding software as another layer of standardization and quality assurance. Syringes were made available to the interventional cardiologist in the cardiac catheterization laboratory suite immediately prior to a scheduled case. Eleven orders of acetylcholine were placed with five dilution syringes per order (total 55 compounded syringes) from the customized acetylcholine provoked coronary vasospasm procedure order panel. Results From January 2020 to March 2021, 11 patients underwent acetylcholine vasoreactivity testing for clinical indications. One patient developed atrial fibrillation with a rapid ventricular rate during provocative testing of the right coronary artery which required elective cardioversion the following day. Of 11 patients, 9 were outpatients and 2 were inpatients. 1 patient received intravenous atropine and ondansetron due to profound bradycardia and nausea after 100mcg acetylcholine administration. No other safety events occurred. Conclusion(s) Provocative testing with intracoronary acetylcholine administration is safe and feasible. For clinical assessment, sterile compounding and customized order panels facilitate routine clinical assessment for patients with suspected vasospastic angina. Nursing protocols should include cardiac monitoring, medications to reverse adverse effects, and possible outcomes of provocative testing. We provide a practical description of our workflow for pharmacists, catheterization laboratory staff, and providers for routine acetylcholine provocation for the evaluation of INOCA. Funding Acknowledgement Type of funding sources: None.
Related Topics
Concepts
Medicine
Cath lab
Coronary artery disease
Pharmacy
Cardiac catheterization
Coronary vasospasm
Angina
Cardiology
Myocardial infarction
Nursing
Conventional PCI
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1093/eurheartj/ehab724.3038
- https://academic.oup.com/eurheartj/article-pdf/42/Supplement_1/ehab724.3038/41050823/ehab724.3038.pdf
- OA Status
- bronze
- Cited By
- 1
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4386871691
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4386871691Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1093/eurheartj/ehab724.3038Digital Object Identifier
- Title
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Developing a multi-disciplinary program for routine acetylcholine vasoreactivity testing in the cardiac catheterization laboratoryWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2021Year of publication
- Publication date
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2021-10-01Full publication date if available
- Authors
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Laurie Tran, M Tuite, S Michaela Serpa, Steffne Kunnirickal, Teresa Esposito, Steven Pfau, SM Tanjil ShahList of authors in order
- Landing page
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https://doi.org/10.1093/eurheartj/ehab724.3038Publisher landing page
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https://academic.oup.com/eurheartj/article-pdf/42/Supplement_1/ehab724.3038/41050823/ehab724.3038.pdfDirect link to full text PDF
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YesWhether a free full text is available
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bronzeOpen access status per OpenAlex
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https://academic.oup.com/eurheartj/article-pdf/42/Supplement_1/ehab724.3038/41050823/ehab724.3038.pdfDirect OA link when available
- Concepts
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Medicine, Cath lab, Coronary artery disease, Pharmacy, Cardiac catheterization, Coronary vasospasm, Angina, Cardiology, Myocardial infarction, Nursing, Conventional PCITop concepts (fields/topics) attached by OpenAlex
- Cited by
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1Total citation count in OpenAlex
- Citations by year (recent)
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2021: 1Per-year citation counts (last 5 years)
- Related works (count)
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10Other works algorithmically related by OpenAlex
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