Comparison of efficacy and safety of intracoronary sodium nitroprusside and intravenous adenosine for assessing fractional flow reserve. Issue 3 (15th October 2012)

• Record Type: Journal Article
• Authors: Rudzinski, Wojciech; Waller, Alfonso H.; Rusovici, Arthur; Dehnee, Abed; Nasur, Ali; Benz, Michael; Sanchez, Salvador; Klapholz, Marc; Kaluski, Edo
• Is Part Of: Catheterization and cardiovascular interventions. Volume 81:Issue 3(2013:Feb. 15)
• Page Start: 540
• Page End: 544
• Publication Date: 2012-10-15
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.24652
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd24652-sec-0001" sec-type="section"> <title>Objectives</title> <p>The purpose of this study was to compare the efficacy and safety of intracoronary (IC) nitroprusside and intravenous adenosine (IVA) for assessing fractional flow reserve (FFR).</p> </sec> <sec id="ccd24652-sec-0002" sec-type="section"> <title>Background</title> <p>IV infusion of adenosine is a standard method to achieve a coronary hyperemia for FFR measurement. However, adenosine is expensive, causes multiple side effects, and is contraindicated in patients with reactive airway disease. Sodium nitroprusside (NTP) is a strong coronary vasodilator but its efficacy and safety for assessing FFR is not well established.</p> </sec> <sec id="ccd24652-sec-0003" sec-type="section"> <title>Methods</title> <p>We compared FFR response and side effects profile of IC NTP and IVA. Bolus of NTP at a dose of 100 μg and IVA (140 μg/kg/min) were used to achieve coronary hyperemia.</p> </sec> <sec id="ccd24652-sec-0004" sec-type="section"> <title>Results</title> <p>We evaluated 75 lesions in 53 patients (60% male) mean age 61.6 ± 13.9 years. Mean FFR after NTP was similar to FFR after adenosine (0.836 ± 0.107 vs. 0.856 ± 0.106; <italic>P</italic> = 0.26; <italic>r</italic> = 0.91, <italic>P</italic> < 0.001). NTP induced maximal stable hyperemia within 10 sec (mean: 6.4 ± 1) which lasted consistently between 38 and 60 sec (mean 51 ± 7.5). NTP caused significant (14%), but asymptomatic decrease in mean blood pressure which returned to baseline within 60 sec. Adenosine caused shortness of breath in 26%, headache and flushing in 19%, and transient second degree heart block in 6% of patients. No adverse symptoms were reported after NTP.</p> </sec> <sec id="ccd24652-sec-0005" sec-type="section"> <title>Conclusions</title> <p>IC NTP is as effective as IVA for measuring FFR. NTP is better tolerated by patients. Since NTP is inexpensive, readily available, well tolerated, and safe, it may be a better choice for FFR assessment. © 2012 Wiley Periodicals, Inc.</p> </sec> </abstract>