title: 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.affiliation: Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Kato
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takashima
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Waseda
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kurita
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kuroda
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosaka
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kuhara
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Ando
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Maeda
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kumagai
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Sakurai
authors.forename: Akihiro
authors.initials: A
authors.lastname: Suzuki
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Toda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.forename: Shigeko
authors.initials: S
authors.lastname: Sato
authors.forename: Masanobu
authors.initials: M
authors.lastname: Fujimoto
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Mizuno
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Amano
mesh_terms: D000255:Adenosine Triphosphate / Q000008:administration & dosage*; D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000187:drug effects*; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology*; D007022:Hypotension / Q000209:etiology; D007261:Infusions, Intra-Arterial; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020108:Nicorandil / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014665:Vasodilator Agents; D020108:Nicorandil; D000255:Adenosine Triphosphate
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