Why the study?
The true incidence of severe bronchospasm related to adenosine administration during coronary angiography is not known.
The incidence of acute bronchospasm during systemic adenosine administration for FFR is extremely low (0.05%), though reactions can be severe and life-threatening.
Rare but serious events warrant vigilance with adenosine; leaves open need for prospective risk-stratification studies.
BACKGROUND: Adenosine is frequently used during coronary angiography to induce hyperaemia and allow operators to perform quantitative measurements of lesion severity. Acute bronchospasm is a recognised side effect relating to the activation of 'off target' A2B receptors. The true incidence of severe bronchospasm relating to adenosine administration is not known. METHODS: Using an electronic patient database, we analysed 100,253 consecutive coronary angiograms over almost 19 years. Fractional flow reserve (FFR) was measured under systemic adenosine in 9,440 cases. RESULTS: Adenosine-related bronchospasm was reported in only five cases (0.05%). One case resulted in a life-threatening respiratory arrest. CONCLUSIONS: This study reveals the incidence of acute bronchospasm during FFR testing to be extremely low. Although rare, these reactions can be severe and are not simply limited to patients with brittle airways disease. Physicians should be aware of the utility of bolus intravenous aminophylline providing targeted therapy to reverse and treat adenosine-related bronchospasm.
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Morrow et al. (2019) studied this question.
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