RESULT OF FOUR INCREASING DOSES OF INTRACORONARY ADENOSINE BOLUS ON FRACTIONAL FLOW RESERVE ASSESSMENT
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Abstract
BACKGROUND: Measuring fractional flow reserve (FFR) via coronary catheter is now the current standard in quantifying the significant physiology of coronary stenosis-induced myocardial ischemia. During the procedure, adenosine, which is an action by inducing capillaries vasodilatation to establish maximal coronary hyperemia, will be administered. Because standard protocol now is adenosine infusion via a large central vein, resulting in disadvantages of the procedure as requiring a large amount of adenosine and vascular catheter insertion to groin or neck region.
OBJECTIVE: To study the effect of four increasing doses of direct intracoronary adenosine bolus (50, 100, 150, 200 mcg) FFR measurement in coronary stenotic lesions in both left and right coronary arteries on the cumulative frequency of FFR ≤0.80 at each dose.
METHODS: A retrospective descriptive research from medical record data on the FFR measurement in patients with coronary stenotic lesions (30-90% diameter stenosis) at Central Chest Institute of Thailand from August 2011 to July 2021 was conducted.
RESULTS: After the exclusion criteria, 1,055 of 1,288 coronary stenotic lesions received further analyses. The number of coronary stenotic lesions with FFR≤0.80, which represented myocardial ischemia, was 233 lesions (22.09%, or about one-fifth of lesions underwent FFR). Compared with the 50 and 100 mcg doses, adenosine 150 and 200 mcg boluses into the left coronary artery increased the cumulative frequency of FFR ≤0.80 from 162/793 lesions (20.43%) to 194/793 lesions (24.46%). The same results also occurred in the right coronary artery; adenosine 150 and 200 mcg boluses increased the cumulative frequency of FFR ≤0.80 from 24/262 lesions (9.16%) to 39/262 lesions (14.89%).
CONCLUSIONS AND RECOMMENDATIONS: FFR measurement with four increasing doses of direct intracoronary adenosine bolus is an alternative to assess myocardial ischemic status. Giving adenosine bolus up to 150 and 200 mcg will increase the cumulative frequency of FFR ≤0.80 in both left and right coronary arteries.
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