Key result
Intravenous adenosine for FFR triggers fatal bronchospasm in a patient with reactive airway disease.
Why the study?
Although bronchospasm is a recognized adverse reaction to adenosine, there have been no prior reports of presumed fatal adenosine-associated bronchospasm during fractional flow reserve testing.
Does intravenous adenosine for fractional flow reserve assessment cause fatal bronchospasm in patients with known airway disease?
Case Report (n=1)
Does intravenous adenosine for fractional flow reserve assessment cause fatal bronchospasm in patients with known airway disease?
Intravenous adenosine used for fractional flow reserve assessment can cause rare but fatal bronchospasm in patients with known obstructive airway disease.
Caution with IV adenosine in known airway disease; case report leaves open true incidence and mitigation during FFR.
BACKGROUND: Adenosine is a commonly used vasodilating agent to induce hyperemia in fractional flow reserve. Most side effects are transient and self-limiting because of its short half-life. CASE SUMMARY: A 79-year-old man with known airway disease underwent coronary angiography for unstable angina. A moderate-to-severe lesion was found in the proximal left anterior descending artery. Pressure wire assessment was undertaken and intravenous adenosine was administered. This resulted in severe bronchospasm progressing to respiratory arrest. Despite resuscitation attempts, the patient did not survive. DISCUSSION: Although bronchospasm is a recognized adverse reaction to adenosine, to our knowledge there have been no prior reports of presumed fatal adenosine-associated bronchospasm during fractional flow reserve testing. TAKE-HOME MESSAGES: Although extremely rare, adenosine carries a risk of fatal bronchospasm, and alternative hyperemic agents or nonhyperemic physiological indices should be used preferentially in patients with known obstructive airway disease. Aminophylline should be immediately available in all clinical settings where adenosine is administered frequently.
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Kim et al. (2026) conducted a case report in unstable angina and known airway disease (n=1). Intravenous adenosine was evaluated on fatal bronchospasm and respiratory arrest. Intravenous adenosine administered for fractional flow reserve assessment in a 79-year-old man with known airway disease resulted in severe, fatal bronchospasm and respiratory arrest.
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