Systematic review and meta-analysis of side effects and severe complications caused by intracoronary pressure measurement

BACKGROUND: Even though current guidelines recommend intracoronary pressure measurement such as fractional flow reserve (FFR) to assess the hemodynamic relevance of angiographically intermediate stenoses, little is known about the incidence of side effects and there is no large-scale data on complications of intracoronary pressure measurements. METHODS: The PubMed database was searched for large multicenter trials and registries of patients undergoing intracoronary pressure measurement. Publications were screened regarding side effects and complications. Data on chest pain, dyspnea, arrhythmia, bronchospasm, hypotension, nausea, and coronary artery injury were collected and analyzed. RESULTS: A total of 19 studies with 22,768 patients were included. FFR measurement was reported to cause chest pain in 29% (95% CI 2-91%), dyspnea in 20%, hypotension in 0.8% (95% CI 0.3-2.1%), vomiting or nausea in 0.9%, and bronchospasm in 0.2% (95% CI 0.0-0.7%) of patients. Arrhythmia occurred in 3% (95% CI 1-16%), more specifically atrioventricular block in 2% (95% CI 0-14%) and ventricular arrhythmia in 0.1% (95% CI 0.1-0.3%), during intracoronary pressure measurement. The pressure wire was reported to have caused coronary artery dissection in 0.2% (95% CI 0.1-0.5%), coronary artery occlusion in 0.2% (95% CI 0.1-0.3%), and coronary artery perforation in 0.1% of patients. Coronary artery injury required revascularization on rare occasions and was fatal in two patients. CONCLUSIONS: Transient side effects due to adenosine administration are common when FFR is measured. While infrequent, coronary artery injury caused by the pressure wire occurs in 0.5% of patients and is a relevant complication of intracoronary pressure measurement.