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IV, intracoronary adenosine yield identical FFR results
Fractional flow reserve measurements were similar during intravenous or intracoronary application of adenosine among patients with an intermediate degree of stenosis.
Researchers systematically compared FFR measurements during intracoronary and IV application of adenosine in a cohort of 114 patients with an intermediate degree of stenosis in coronary angiography. They performed two FFR measurements during intracoronary bolus injection of adenosine (40 µg for the right and 80 µg for the left coronary artery), and two measurements during continuous IV infusion (140 µg/kg per minute). At each measurement, the clinicians recorded FFR value, time to reach FFR and patient discomfort on a scale of zero to five for symptoms.
Patients in the IV group experienced a mean time to FFR of 100 ± 27 seconds vs. 23 ± 14 seconds for the intracoronary group (P < .001).
Intracoronary administration of adenosine yielded lower outcomes on the discomfort scale than the IV infusion (subjective scale > 0 in 35.1% vs. 87.7%; P < .001).
Clinicians observed a close correlation between the IV and intracoronary groups (r = 0.99; P < .001). Results of the Bland-Altman analysis indicated no systematic bias (0.002; 95 CI, −0.001 to 0.005). Inter-method variability also was low, at 1.56%, according to the researchers. There also was no intra-method variability between IV (1.47%) and intracoronary (1.33%) administration of adenosine (P = .5).
Left ventricular ejection fraction of up to 35% occurred in 11.3% of patients in the overall cohort. FFR measurements were as close between the IV and intracoronary groups among this LVEF subgroup as they were for the full cohort.
A mean difference of −0.007 ± 0.017 (95% CI, −0.016 to 0.001) was reported for IV FFR measurements. These measurements had a variability of 1.66%.
For the intracoronary group, FFR values differed by a mean of 0.003 ± 0.01 (95% CI, −0.002 to 0.007), with a variability of 0.8%.
“Our data convincingly demonstrate that both about the obtained FFR values, as well as about intrapatient variability, intracoronary administration of adenosine is not inferior to [IV] infusion,” the researchers concluded. “Given the logistic advantages of intra-coronary bolus injection, as well as increased patient comfort and lower cost, intracoronary adenosine injection may become the preferred route of administration in the future.” – by Rob Volansky
Disclosure: The researchers report receiving grants and honoraria from Abbott and Siemens and proctor lecture fees from St. Jude Medical.