Due to a growing recognition of coronary artery spasm as an important pathophysiologic mechanism in myocardial ischemia/infarction with no obstructive coronary arteries (INOCA/MINOCA) along with a recent study validating the safety of intracoronary (IC) administration of acetylcholine (ACh) for its diagnosis [ ], the uptake of provocative testing with IC ACh has been increasing in the US. However, there is currently a national shortage of ACh, significantly limiting the ability of most institutions to perform provocative testing with ACh.