Feasibility and safety of intracoronary nicorandil infusion as a novel hyperemic agent for fractional flow reserve measurements.

Abstract

Fractional flow reserve (FFR) is a useful modality to assess the functional significance of coronary stenoses. Although adenosine triphosphate (ATP) is generally used as the hyperemic stimulus, we sometimes encounter adverse events like hypotension during FFR measurement. Nicorandil, an ATP-sensitive potassium channel opener, recognized as an epicardial and resistance vessel dilator, has not been fully evaluated as a possible alternative hyperemic agent. The aim of this study was to evaluate the feasibility and safety of intracoronary nicorandil infusion compared to intravenous ATP for FFR measurement in patients with coronary artery disease. A total of 102 patients with 124 intermediate lesions (diameter stenosis >40 and <70% by visual assessment) were enrolled. All vessels underwent FFR measurements with both ATP (150 μg/kg/min) and nicorandil (2.0 mg) stimulus. FFR, hemodynamic values, and periprocedural adverse events between the two groups were evaluated. A strong correlation was observed between FFR with ATP and FFR with nicorandil (r = 0.954, p < 0.001). The agreement between the two sets of measurements was also high, with a mean difference of 0.01 ± 0.03. The mean aortic pressure drop during pharmacological stimulus was significantly larger with ATP compared to nicorandil (9.6 ± 9.6 vs. 5.5 ± 5.8 mmHg, p < 0.001). During FFR measurement, transient atrioventricular block was frequently observed with ATP compared to nicorandil (4.0 vs. 0%, p = 0.024). This study suggests that intracoronary nicorandil infusion is associated with clinical utility and safety compared to ATP as an alternative hyperemic agent for FFR measurement.

• Authors: Daiki Kato, Hiroaki Takashima, Katsuhisa Waseda, Akiyoshi Kurita, Yasuo Kuroda, Takashi Kosaka, Yasushi Kuhara, Hirohiko Ando, Kazuyuki Maeda, Soichiro Kumagai, Shinichiro Sakurai, Akihiro Suzuki, Yukiko Toda, Atsushi Watanabe, Shigeko Sato, Masanobu Fujimoto, Tomofumi Mizuno, Tetsuya Amano
• Journal: Heart and vessels (Heart Vessels) Vol. 30 Issue 4 Pg. 477-83 (Jul 2015) ISSN: 1615-2573 [Electronic] Japan
• PMID: 24748047 (Publication Type: Clinical Study, Comparative Study, Journal Article)

Chemical References

• Vasodilator Agents
• Nicorandil
• Adenosine Triphosphate

Topics

• Adenosine Triphosphate (administration & dosage)
• Aged
• Coronary Angiography
• Coronary Stenosis (diagnostic imaging)
• Female
• Fractional Flow Reserve, Myocardial (drug effects)
• Hemodynamics
• Humans
• Hyperemia (physiopathology)
• Hypotension (etiology)
• Infusions, Intra-Arterial
• Linear Models
• Male
• Middle Aged
• Nicorandil (administration & dosage, adverse effects)
• Prospective Studies
• Vasodilator Agents (administration & dosage, adverse effects)