title: The use of the acute Pd/Pa drop after intracoronary nitroglycerin infusion to rule out significant FFR: CANICA (Can intracoronary nitroglycerin predict fractional flow reserve without adenosine?) multicenter study.
abstract: OBJECTIVE
  Functional assessment of coronary artery stenosis is performed by measuring the fractional flow reserve (FFR) under hyperemic conditions (Adenosine). However, the use of adenosine portends limitations.
  
  
  OBJECTIVE
  We sought to investigate the relationship and correlation between FFR and the Pd/Pa value obtained just after the intracoronary infusion (acute drop) of nitroglycerin (Pd/Pa-NTG) and if this parameter enhances diagnostic accuracy for FFR prediction compared to the resting baseline Pd/Pa.
  
  
  METHODS
  We conducted a multicenter study including prospectively patients presenting intermediate coronary artery stenosis (30-70%) evaluated with pressure wire. Resting baseline Pd/Pa, Pd/Pa-NTG and FFR were measured.
  
  
  RESULTS
  283 patients (335 lesions) were included. Resting baseline Pd/Pa value was 0.72 to 1.0 (0.93 ± 0.04), Pd/Pa-NTG was 0.60 to 1.0 (0.87 ± 0.07) and FFR 0.55 to 1.0 (0.83 ± 0.08). The ROC curves for resting baseline Pd/Pa and for Pd/Pa-NTG, using a FFR ≤ 0.80 showed an AUC of 0.88 (95% CI: 0.84-0.92, P < 0.001) and 0.94 (95% CI: 0.92-0.96, P < 0.001) respectively. The optimal cutoff values of resting baseline Pd/Pa and Pd/Pa-NTG for an FFR > 0.80, were >0.96 and >0.88, respectively. These values were present in a 29.8% (n = 100) and a 47.1% (n = 158), of the total lesions. Scatter plots showed a better correlation and agreement points with Pd/Pa-NTG than resting baseline Pd/Pa. The cutoff value of Pd/Pa-NTG > 0.88 showed an excellent NPV (96.2% for FFR > 0.8 and 100% for FFR > 0.75) and sensitivity (95% for FFR > 0.8 and 100% for FFR > 0.75) which were consistently high across all the subgroups analysis.
  
  
  CONCLUSIONS
  The cutoff value of acute Pd/Pa-NTG > 0.88 has a high NPV meaning adenosine-FFR can be avoided in almost half of lesions.
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Fundacion Jimenez Diaz-IDC Salud, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Martin-Reyes
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Marques De Valdecilla, Santander, Cantabria Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: de la Torre Hernandez
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Fundacion Jimenez Diaz-IDC Salud, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Franco-Pelaez
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario San Juan, Alicante, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Lopez-Palop
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Policlinica Gipuzkoa, San Sebastian, Guipuzcoa, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Telleria Arrieta
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Clinico Universitario, Valladolid, Spain.
authors.forename: I J
authors.initials: IJ
authors.lastname: Amat Santos
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario San Juan, Alicante, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Carrillo Saez
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Univesitario La Paz, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sanchez-Recalde
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Policlinica Gipuzkoa, San Sebastian, Guipuzcoa, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Sanmartin Pena
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Marques De Valdecilla, Santander, Cantabria Spain.
authors.forename: T
authors.initials: T
authors.lastname: Garcia Camarero
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Clinic, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Clinico Universitario, Valladolid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Gimeno de Carlos
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Fundacion Jimenez Diaz-IDC Salud, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Pinero
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Marques De Valdecilla, Santander, Cantabria Spain.
authors.forename: D C
authors.initials: DC
authors.lastname: Sorto Sanchez
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario San Juan, Alicante, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Frutos
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Policlinica Gipuzkoa, San Sebastian, Guipuzcoa, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Lasa Larraya
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Fundacion Jimenez Diaz-IDC Salud, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Navarro
authors.affiliation: Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Fundacion Jimenez Diaz-IDC Salud, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Farre
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D019540:Area Under Curve; D062186:Arterial Pressure; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007261:Infusions, Intra-Arterial; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013030:Spain; D019564:Unnecessary Procedures; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin; D000241:Adenosine
keywords: fractional flow reserve; microcirculation; pressure wire