Comparison of efficacy and safety of intracoronary nicardipine and adenosine for fractional flow reserve assessment of coronary stenosis.

BACKGROUND: Administration of intracoronary (IC) adenosine allows an easily feasible, inexpensive, and more rapid alternative method for fractional flow reserve (FFR). It is common practice in many centers worldwide. Nicardipine is a strong coronary vasodilator but its efficacy and safety for assessing FFR is not established. The purpose of present study was to compare the efficacy and safety of IC nicardipine and adenosine for assessing FFR. METHODS: One hundred and fifty-nine patients with a total of 193 vessels undergoing clinically indicated FFR assessment of intermediate coronary stenoses were included. For the initial assessment of FFR, hyperemia was induced by an IC adenosine. After a washout period of 3 min, FFR was reassessed using 200 µg of IC nicardipine. RESULTS: Hyperemic efficacy among two different stimuli was compared. The mean FFR with IC adenosine was 0.83 ± 0.09 and that with an IC nicardipine was 0.84 ± 0.09. The median FFR with an IC adenosine was 0.83 (0.78-0.91) and that with an IC nicardipine was 0.85 (0.79-0.91) (p-value 0.246). Both FFR values showed an excellent correlation (R2 = 0.982, p < 0.001). Nicardipine produced fewer changes in heart rate, less chest pain and less flushing than adenosine. Transient atrioventricular block occurred in 29 patients with IC adenosine and none with IC nicardipine. CONCLUSIONS: IC bolus injection of nicardipine could be introduced as a safe and practical alternative method of inducing hyperemia during FFR measurements. Compared to IC adenosine, IC nicardipine has a similar hyperemic efficacy and excellent side-effect profile.

Fractional flow reserve guided coronary revascularization in drug-eluting era in Thai patients with borderline multi-vessel coronary stenoses.

BACKGROUND: Previous studies have shown the cost benefit of fractional flow reserve (FFR)--guided coronary revascularization in the patient with multivessel borderline coronary artery stenoses. However; they have been performed in the Bare-metal stent era. It is a challenge to demonstrate the benefit of the FFR-guided coronary revascularization in the patient with multivessel coronary disease (MVD) in the drug-eluting era in Thai patients. MATERIAL AND METHOD: Forty-nine patients with MVD (71 stenotic vessels) underwent FFR-guided revascularization (FFR group) compared with forty-nine patients with MVD (79 stenotic vessels) underwent traditional PCI (Traditional group) on the basis of visual estimation of the stenotic lesion. PCI has been performed in the FFR group patient with FFR value < or =0.75, whereas those with FFR value > or = 0.75 continued on medical treatment. The event rates of chest pain, repeat revascularization, hospitalization, myocardial infarction and death were compared between both groups. Total costs incurred in the catheterization laboratory, including the cost of stent, balloon, pressure guide wire, contrast media and other supplies, were computed between both groups. RESULTS: In FFR group: in 46 vessels, FFR was 0.87 +/- 0.06 and PCI was avoided, the other 25 vessels, baseline FFR was 0.65 +/- 0.09 and were underwent PCI. Two patients proceed CABG In the traditional PCI group: 79 vessels were underwent PCI. In comparison of event free survival between the FFR and the traditional PCI groups during follow-up (mean follow-up 8.27 +/- 5.45 vs. 9.49 + 5.39 months), they were not different in MACE, chest pain, repeat revascularization, hospitalization, myocardial infarction and death (8.2% vs. 13.3%, p = 0.33). The average total cost saving per patient was 63,290 Baht (p < 0.001). CONCLUSION: For patients with borderline MVD, FFR-guided coronary revascularization with drug eluting stent placement could save a total cost per patient at 63,290 Bath without compromising safety.