August 27, 2001Catheterization and Cardiovascular Interventions
Incremental doses of intracoronary adenosine for the assessment of coronary velocity reserve for clinical decision making
Why the study?
Do incremental doses of intracoronary adenosine yield more complete vasodilation and higher coronary velocity reserve measurements compared to a single initial dose in patients undergoing cardiac catheterization?
Population
457 patients undergoing cardiac catheterization, divided into Group I without angiographic evidence of…
Comparison
Incremental doses of intracoronary adenosine vs Initial dose of intracoronary adenosine
Design
Cohort
Authors
Discussion
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Implication
Single-dose adenosine may underestimate maximal CVR; this Level 3 finding leaves open whether incremental protocols warrant prospective validation before practice change.
Structured PICO
Do incremental doses of intracoronary adenosine yield more complete vasodilation and higher coronary velocity reserve measurements compared to a single initial dose in patients undergoing cardiac catheterization?
P
Population
457 patients undergoing cardiac catheterization, divided into Group I (n=319) without angiographic evidence of significant coronary artery disease, and Group II (n=138) with intermediate coronary stenoses (40% to 70% diameter stenosis).
I
Intervention
Incremental doses of intracoronary adenosine (12 to 54 microg for the left coronary artery and 6 to 42 microg for the right coronary artery)
C
Comparator
Initial dose of intracoronary adenosine (within-patient comparison)
O
Outcome
Maximal coronary velocity reserve (CVR) measured using a Doppler-tipped guidewiresurrogate
Incremental doses of intracoronary adenosine are necessary to achieve maximal coronary velocity reserve, as relying on a single initial dose may falsely classify a significant proportion of patients as having abnormal microvascular function.
Cite This Study
Segni et al. (2001) studied this question.