Intracoronary SNP vs Adenosine for Fractional Flow Reserve
The purpose of this study was to compare the efficacy and safety of intracoronary (IC) sodium nitroprusside (SNP) and IC adenosine (AD) for fractional flow reserve (FFR) measurement. We compared the FFR response and side effect profiles of IC AD and IC SNP in 40 patients with a combined total of 53 moderate coronary stenoses. Boluses of AD at doses of 40 μg (A1) and 60 μg (A2), and SNP at doses of 0.3 μg/kg (S1), 0.6 μg/kg (S2), and 0.9 μg/kg (S3) were used to achieve coronary hyperemia. The mean FFR value decreased significantly by 7.96% (A1), 10.51% (A2), 8.74% (S1), 10.58% (S2), and 10.73% (S3) compared with the baseline distal coronary pressure/aortic pressure. IC SNP delayed the mean time to peak value of FFR by 87.5%, 79.0%, and 88.6% in S1, S2, and S3, respectively, compared with A2 (P<.001). The mean duration of the plateau phase was longer in S1 (50.47 ± 14.25 s), S2 (51.33 ± 16.41 s) and S3 (57.60 ± 18.07 s) compared with A2 (27.93 ± 11.90 s; P<.01). IC AD caused shortness of breath in 11 patients (27.5%), flushing in 4 patients (10%), headache in 8 patients (20%), and transient second-degree atrioventricular block (AVB) in 6 patients (15%). IC SNP may be used as a hyperemic agent in FFR measurements. It may be preferable to IC AD as a routine clinical stimulus and has the additional advantage of showing a longer plateau phase.
Fractional flow reserve (FFR) measurement is used to assess the hemodynamic significance of coronary arterial stenosis. Studies have shown that patients with an FFR measurement of <0.75 almost always present with myocardial ischemia. In patients with coronary stenosis based on coronary angiography (CAG) and an FFR of ≥0.75, deferral of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) is safe in daily clinical practice and reduces costs. In multivessel coronary artery disease, FFR-guided PCI shows improved clinical outcomes compared to CAG-guided strategies.
When FFR is measured, pharmacologic stimuli are needed to induce coronary hyperemia. Intravenous (IV) adenosine infusion is currently considered the gold standard for FFR evaluation. However, the intracoronary (IC) administration of vasodilator agents, such as adenosine (AD) or sodium nitroprusside (SNP), represents a valuable alternative in everyday practice, theoretically allowing delivery of a higher drug concentration into coronary circulation and reducing the occurrence of systemic symptoms. Parham et al found that IC SNP produces similar, but longer, periods of hyperemia than IC adenosine. They also found that when induced with IC SNP, the measured FFR values correlate well with the FFR values measured with IC adenosine. However, this study was limited to 21 patients with normal coronary arteries and 9 patients with single-vessel coronary artery disease.
The aim of this study was to compare the FFR response and side effect profiles of IC adenosine and IC SNP in patients with single-vessel and multivessel coronary artery stenoses identified by coronary angiography.
Abstract and Introduction
Abstract
The purpose of this study was to compare the efficacy and safety of intracoronary (IC) sodium nitroprusside (SNP) and IC adenosine (AD) for fractional flow reserve (FFR) measurement. We compared the FFR response and side effect profiles of IC AD and IC SNP in 40 patients with a combined total of 53 moderate coronary stenoses. Boluses of AD at doses of 40 μg (A1) and 60 μg (A2), and SNP at doses of 0.3 μg/kg (S1), 0.6 μg/kg (S2), and 0.9 μg/kg (S3) were used to achieve coronary hyperemia. The mean FFR value decreased significantly by 7.96% (A1), 10.51% (A2), 8.74% (S1), 10.58% (S2), and 10.73% (S3) compared with the baseline distal coronary pressure/aortic pressure. IC SNP delayed the mean time to peak value of FFR by 87.5%, 79.0%, and 88.6% in S1, S2, and S3, respectively, compared with A2 (P<.001). The mean duration of the plateau phase was longer in S1 (50.47 ± 14.25 s), S2 (51.33 ± 16.41 s) and S3 (57.60 ± 18.07 s) compared with A2 (27.93 ± 11.90 s; P<.01). IC AD caused shortness of breath in 11 patients (27.5%), flushing in 4 patients (10%), headache in 8 patients (20%), and transient second-degree atrioventricular block (AVB) in 6 patients (15%). IC SNP may be used as a hyperemic agent in FFR measurements. It may be preferable to IC AD as a routine clinical stimulus and has the additional advantage of showing a longer plateau phase.
Introduction
Fractional flow reserve (FFR) measurement is used to assess the hemodynamic significance of coronary arterial stenosis. Studies have shown that patients with an FFR measurement of <0.75 almost always present with myocardial ischemia. In patients with coronary stenosis based on coronary angiography (CAG) and an FFR of ≥0.75, deferral of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) is safe in daily clinical practice and reduces costs. In multivessel coronary artery disease, FFR-guided PCI shows improved clinical outcomes compared to CAG-guided strategies.
When FFR is measured, pharmacologic stimuli are needed to induce coronary hyperemia. Intravenous (IV) adenosine infusion is currently considered the gold standard for FFR evaluation. However, the intracoronary (IC) administration of vasodilator agents, such as adenosine (AD) or sodium nitroprusside (SNP), represents a valuable alternative in everyday practice, theoretically allowing delivery of a higher drug concentration into coronary circulation and reducing the occurrence of systemic symptoms. Parham et al found that IC SNP produces similar, but longer, periods of hyperemia than IC adenosine. They also found that when induced with IC SNP, the measured FFR values correlate well with the FFR values measured with IC adenosine. However, this study was limited to 21 patients with normal coronary arteries and 9 patients with single-vessel coronary artery disease.
The aim of this study was to compare the FFR response and side effect profiles of IC adenosine and IC SNP in patients with single-vessel and multivessel coronary artery stenoses identified by coronary angiography.
SHARE
