TY - JOUR
T1 - Comparison of the prognostic value of non-ischaemic fractional flow reserve using intracoronary versus intravenous adenosine
AU - Pothineni, Naga Venkata K.
AU - Edupuganti, Mohan M.
AU - Almomani, Ahmed
AU - Payne, Jason
AU - Raina, Sameer
AU - Fnu, Shailesh
AU - Abualsuod, Amjad
AU - Wong, Joseph
AU - Uretsky, Barry F.
AU - Hakeem, Abdul
N1 - Publisher Copyright:
© Europa Digital & Publishing 2018. All rights reserved.
PY - 2018/2
Y1 - 2018/2
N2 - Aims: Intracoronary adenosine (ICA) yields similar fractional flow reserve (FFR) results to the "gold standard" of intravenous adenosine (IVA). Whether they have similar prognostic significance is unknown. We therefore sought to study the prognostic value of the route of adenosine administration for the measurement of FFR in deferred coronary lesions in a large, real-world cohort. Methods and results: Five hundred and seventy-six patients with 787 lesions in whom PCI was deferred based on FFR >0.75 were studied. The primary outcome was the first major adverse cardiovascular event (MACE; defined as death, myocardial infarction [MI], or target vessel revascularisation [TVR]), and the secondary outcome was a composite of MI and target vessel failure (TVF). FFR was measured with ICA in 426 lesions and IVA in 361 lesions. Median follow-up duration was 3.2 years (interquartile range: 1.7-4.6). Propensity-matched cohorts of ICA and IVA were well matched for baseline clinical, angiographic and haemodynamic characteristics. In the propensity-matched cohort, MACE occurred in 23.5% of the ICA group and in 22.3% of the IVA group (p=0.29). On multivariate analysis, acute coronary syndrome, FFR and prior MI/revascularisation were independent predictors of MACE and MI/TVF. The route of adenosine administration was not predictive of MACE or MI/TVF. Conclusions: ICA and IVA yield similar FFR values and show comparable long-term prognostic utility in a deferred population. These findings provide confirmation that non-ischaemic FFR using a simpler ICA protocol provides prognostic data similar to the gold standard IVA.
AB - Aims: Intracoronary adenosine (ICA) yields similar fractional flow reserve (FFR) results to the "gold standard" of intravenous adenosine (IVA). Whether they have similar prognostic significance is unknown. We therefore sought to study the prognostic value of the route of adenosine administration for the measurement of FFR in deferred coronary lesions in a large, real-world cohort. Methods and results: Five hundred and seventy-six patients with 787 lesions in whom PCI was deferred based on FFR >0.75 were studied. The primary outcome was the first major adverse cardiovascular event (MACE; defined as death, myocardial infarction [MI], or target vessel revascularisation [TVR]), and the secondary outcome was a composite of MI and target vessel failure (TVF). FFR was measured with ICA in 426 lesions and IVA in 361 lesions. Median follow-up duration was 3.2 years (interquartile range: 1.7-4.6). Propensity-matched cohorts of ICA and IVA were well matched for baseline clinical, angiographic and haemodynamic characteristics. In the propensity-matched cohort, MACE occurred in 23.5% of the ICA group and in 22.3% of the IVA group (p=0.29). On multivariate analysis, acute coronary syndrome, FFR and prior MI/revascularisation were independent predictors of MACE and MI/TVF. The route of adenosine administration was not predictive of MACE or MI/TVF. Conclusions: ICA and IVA yield similar FFR values and show comparable long-term prognostic utility in a deferred population. These findings provide confirmation that non-ischaemic FFR using a simpler ICA protocol provides prognostic data similar to the gold standard IVA.
KW - Adjunctive pharmacotherapy
KW - Fractional flow reserve
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U2 - 10.4244/EIJ-D-16-00375
DO - 10.4244/EIJ-D-16-00375
M3 - Article
C2 - 28606887
AN - SCOPUS:85044027585
SN - 1774-024X
VL - 13
SP - 1680
EP - 1687
JO - EuroIntervention
JF - EuroIntervention
IS - 14
ER -