title: Safety of guidewire-based measurement of fractional flow reserve and the index of microvascular resistance using intravenous adenosine in patients with acute or recent myocardial infarction.
abstract: OBJECTIVE
  Coronary guidewire-based diagnostic assessments with hyperemia may cause iatrogenic complications. We assessed the safety of guidewire-based measurement of coronary physiology, using intravenous adenosine, in patients with an acute coronary syndrome.
  
  
  METHODS
  We prospectively enrolled invasively managed STEMI and NSTEMI patients in two simultaneously conducted studies in 6 centers (NCT01764334; NCT02072850). All of the participants underwent a diagnostic coronary guidewire study using intravenous adenosine (140 μg/kg/min) infusion for 1-2 min. The patients were prospectively assessed for the occurrence of serious adverse events (SAEs) and symptoms and invasively measured hemodynamics were also recorded.
  
  
  RESULTS
  648 patients (n=298 STEMI patients in 1 hospital; mean time to reperfusion 253 min; n=350 NSTEMI in 6 hospitals; median time to angiography from index chest pain episode 3 (2, 5) days) were included between March 2011 and May 2013. Two NSTEMI patients (0.3% overall) experienced a coronary dissection related to the guidewire. No guidewire dissections occurred in the STEMI patients. Chest symptoms were reported in the majority (86%) of patient's symptoms during the adenosine infusion. No serious adverse events occurred during infusion of adenosine and all of the symptoms resolved after the infusion ceased.
  
  
  CONCLUSIONS
  In this multicenter analysis, guidewire-based measurement of FFR and IMR using intravenous adenosine was safe in patients following STEMI or NSTEMI. Self-limiting symptoms were common but not associated with serious adverse events. Finally, coronary dissection in STEMI and NSTEMI patients was noted to be a rare phenomenon.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Layland
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: David
authors.initials: D
authors.lastname: Carrick
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Petrie
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: McEntegart
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Hany
authors.initials: H
authors.lastname: Eteiba
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Hood
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Lindsay
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Watkins
authors.affiliation: Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davie
authors.affiliation: Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mahrous
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Carberry
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
authors.forename: Vannesa
authors.initials: V
authors.lastname: Teng
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: University Hospital Southampton Foundation Trust, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Curzen
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
authors.forename: Keith G
authors.initials: KG
authors.lastname: Oldroyd
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK. Electronic address: colin.berry@glasgow.ac.uk.
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000494:pharmacology*; D017023:Coronary Angiography; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D006113:United Kingdom; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: Adenosine; Blood pressure (BP); Heart rate (HR); Non ST-elevation myocardial infarction (NSTEMI); Percutaneous coronary intervention (PCI); ST-elevation myocardial infarction (STEMI)