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Wijntjens GWM, van Uffelen EL, Echavarría-Pinto M, Casadonte L, Stegehuis VE, Murai T, Marques KMJ, Yoon MH, Tahk SJ, Casella G, Leone AM, López Palop R, Schlundt C, Rivero F, Petraco R, Fearon WF, Johnson NP, Jeremias A, Koo BK, Piek JJ, van de Hoef TP. Individual Lesion-Level Meta-Analysis Comparing Various Doses of Intracoronary Bolus Injection of Adenosine With Intravenous Administration of Adenosine for Fractional Flow Reserve Assessment. Circ Cardiovasc Interv 2019; 13:e007893. [PMID: 31870178 DOI: 10.1161/circinterventions.119.007893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intravenous infusion of adenosine is considered standard practice for fractional flow reserve (FFR) assessment but is associated with adverse side-effects and is time-consuming. Intracoronary bolus injection of adenosine is better tolerated by patients, cheaper, and less time-consuming. However, current literature remains fragmented and modestly sized regarding the equivalence of intracoronary versus intravenous adenosine. We aim to investigate the relationship between intracoronary adenosine and intravenous adenosine to determine FFR. METHODS We performed a lesion-level meta-analysis to compare intracoronary adenosine with intravenous adenosine (140 µg/kg per minute) for FFR assessment. The search was conducted in accordance to the Preferred Reporting for Systematic Reviews and Meta-Analysis statement. Lesion-level data were obtained by contacting the respective authors or by digitization of scatterplots using custom-made software. Intracoronary adenosine dose was defined as; low: <40 µg, intermediate: 40 to 99 µg, and high: ≥100 µg. RESULTS We collected 1972 FFR measurements (1413 lesions) comparing intracoronary with intravenous adenosine from 16 studies. There was a strong correlation (correlation coefficient =0.915; P<0.001) between intracoronary-FFR and intravenous-FFR. Mean FFR was 0.81±0.11 for intracoronary adenosine and 0.81±0.11 for intravenous adenosine (P<0.001). We documented a nonclinically relevant mean difference of 0.006 (limits of agreement: -0.066 to 0.078) between the methods. When stratified by the intracoronary adenosine dose, mean differences between intracoronary and intravenous-FFR amounted to 0.004, 0.011, or 0.000 FFR units for low-dose, intermediate-dose, and high-dose intracoronary adenosine, respectively. CONCLUSIONS The present study documents clinically irrelevant differences in FFR values obtained with intracoronary versus intravenous adenosine. Intracoronary adenosine hence confers a practical and patient-friendly alternative for intravenous adenosine for FFR assessment.
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Affiliation(s)
- Gilbert W M Wijntjens
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Ellen L van Uffelen
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Mauro Echavarría-Pinto
- Hospital General ISSSTE - Facultad de Medicina, Universidad Autónoma de Querétaro, México (M.E.-P.)
| | - Lorena Casadonte
- Department of Biomedical Engineering and Physics (L.C.), Amsterdam-Universitair Medische Centra, locatie-AMC, the Netherlands
| | - Valérie E Stegehuis
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Tadashi Murai
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Koen M J Marques
- Department of Cardiology, Amsterdam-Universitair Medische Centra, locatie VUmc, Amsterdam, the Netherlands (K.M.J.M.)
| | - Myeong-Ho Yoon
- Department of Cardiology, Ajou University, Suwon, Republic of Korea (M.-H.Y., S.-J.T.)
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University, Suwon, Republic of Korea (M.-H.Y., S.-J.T.)
| | - Gianni Casella
- Department of Cardiology, Ospedale Maggiore, Bologna, Italy (G.C.)
| | - Antonio M Leone
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (A.M.L.)
| | - Ramón López Palop
- Department of Cardiology, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Spain (R.L.-P.)
| | | | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain (F.R.)
| | | | - William F Fearon
- Department of Cardiology, Stanford University School of Medicine, Stanford Cardiovascular Institute (W.F.F.)
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston (N.P.J.)
| | - Allen Jeremias
- St Francis Hospital, Roslyn, Cardiovascular Research Foundation, New York, NY (A.J.)
| | - Bon-Kwon Koo
- Seoul National University College of Medicine, Republic of Korea (B.-K.K.)
| | - Jan J Piek
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Tim P van de Hoef
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
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Koh KT, Said A, Chee Sin K, Yen Yee O, Mulia E, Ting TC, Eng Pbeng FS, Hui HK, Yen VC, Ling CY, Zan KN, Mohd Amin NH, Yean Yip AF, Kiam OT. Predictive Value of Resting Pd/Pa for Fractional Flow Reserve Assessed with Monorail Pressure Microcatheter in Real-World Practice. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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