Key result
High-dose escalation of intracoronary adenosine increased the frequency of detecting a fractional flow reserve ≤0.8 from 34.6% to 41.8% compared to conventional doses, without major complications.
Why the study?
Maximal hyperaemia for FFR may not be achieved with recommended doses of intracoronary adenosine, and real-world data from a large cohort are needed to evaluate FFR results and the safety of high-dose escalation.
Does high-dose escalation of intracoronary adenosine improve the detection of ischemic FFR (≤0.8) in patients undergoing fractional flow reserve assessment?
Cohort (n=878)
Yes
Does high-dose escalation of intracoronary adenosine improve the detection of ischemic FFR (≤0.8) in patients undergoing fractional flow reserve assessment?
High-dose escalation of intracoronary adenosine safely increases the detection of ischemic FFR (≤0.8), particularly in vessels with borderline FFR values (0.81-0.85) at conventional doses.
High-dose adenosine escalation was associated with higher ischemic FFR detection; hypothesis-generating and requires randomized trials before practice change.
Maximal hyperaemia for fractional flow reserve (FFR) may not be achieved with the current recommended doses of intracoronary adenosine. Higher doses (up to 720 μg) have been reported to optimize hyperaemic stimuli in small dose-response studies. Real-world data from a large cohort of patients is needed to evaluate FFR results and the safety of high-dose escalation. This is a retrospective study aimed to evaluate the safety and frequency of FFR ≤0.8 after high-dose escalation of intracoronary adenosine. Data were extracted from the medical databases of two university hospitals. Increasing doses (100, 200, 400, 600, and 800 μg) of adenosine were administered as intracoronary boluses until FFR ≤0.8 was achieved or heart block developed. The percentage of FFR ≤0.8 after higher-dose escalation was compared with those at conventional doses, and the predictors for FFR ≤0.8 after higher doses were analysed. In the 1163 vessels of 878 patients, 402 vessels (34.6%) achieved FFR ≤0.8 at conventional doses and 623 vessels (53.6%) received high-dose escalation. An additional 84 vessels (13.5%) achieved FFR ≤0.8 after high-dose escalation. No major complications developed during high-dose escalation. Borderline FFR (0.81-0.85) at the conventional dose, stenosis >60%, and triple-vessel disease increased the likelihood of FFR ≤0.8 after high-dose escalation, but chronic kidney disease decreased it. For vessels of borderline FFR at conventional doses, 46% achieved FFR ≤0.8 after high-dose escalation. In conclusion, High-dose escalation of intracoronary adenosine increases the frequency of FFR ≤0.8 without major complications. It could be especially feasible for borderline FFR values near the 0.8 diagnostic threshold.
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Jong et al. (2020) conducted a cohort in Coronary artery disease (n=878). High-dose escalation of intracoronary adenosine vs. Conventional dose intracoronary adenosine was evaluated on Fractional flow reserve (FFR) ≤0.8. High-dose escalation of intracoronary adenosine increased the frequency of detecting a fractional flow reserve ≤0.8 from 34.6% to 41.8% compared to conventional doses, without major complications.
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