High dose escalation of intracoronary adenosine in the assessment of fractional flow reserve: A retrospective cohort study

• Published in: PloS one Vol. 15; no. 10; p. e0240699
• Main Authors: Jong, Chien-Boon, Lu, Tsui-Shan, Yan-Tyng Liu, Patrick, Hsieh, Mu-Yang, Meng, Shih-Wei, Huang, Ching-Chang, Kao, Hsien-Li, Wu, Chih-Cheng
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15-10-2020; Public Library of Science (PLoS)
• Subjects: Adenosine; Adenosine - pharmacology; Aged; Biology and Life Sciences; Blood flow; Blood vessels; Cardiac patients; Cardiology; Cardiovascular disease; Cohort analysis; Complications; Coronary Angiography; Coronary vessels; Coronary Vessels - drug effects; Coronary Vessels - physiology; Diagnostic systems; Dosage and administration; Dose-Response Relationship, Drug; Drug dosages; Drug therapy; Evaluation; Female; Fractional Flow Reserve, Myocardial; Health aspects; Heart attacks; Heart function tests; Hospitals; Humans; Hyperemia; Internal medicine; Kidney diseases; Male; Medical databases; Medical examination; Medical imaging; Medical records; Medical schools; Medicine; Medicine and Health Sciences; Methods; Patient outcomes; Patients; People and Places; Retrospective Studies; Safety; Statistics; Stenosis; Variables; Taiwan; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0240699

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.