title: Impact of additional intracoronary nicorandil administration during fractional flow reserve measurement with intravenous adenosine 5'-triphosphate infusion.
abstract: Fractional flow reserve (FFR) is a useful index for determining the functional severity of epicardial coronary artery stenosis as an invasive physiological method. Although intravenous adenosine 5'-triphosphate (ATP) is generally used as a hyperemic agent for FFR measurement in Japan, there are some concerns about the variability of FFR measurement (short half-life, effect of caffeine, cyclic change). It is difficult to confirm sufficient maximum hyperemia after ATP infusion. Recent studies reported that nicorandil (NIC) could be an alternative to ATP as a hyperemic agent.
  
  
  
  Patients who underwent FFR assessments of angiographically intermediate lesions were included. All patients were asked to refrain from caffeine-containing products more than 12hours before FFR measurements. All patients first received intravenous (IV) ATP infusion (180μg/kg/min) for 3min to measure FFR (ATP-FFR). After additional intracoronary (IC) NIC administration (2mg/30s) during ATP infusion, FFR was measured again (NIC-FFR). To check cyclic change in FFR, we measured minimum and maximum FFR values during both ATP and NIC hyperemic phase.
  
  
  
  In this study, 94 patients with 94 lesions were enrolled. Mean FFR value was 0.81±0.10 in ATP-FFR infusion and 0.80±0.09 in NIC-FFR, respectively. ATP-FFR and NIC-FFR had a strong correlation on the whole (r=0.92, p<0.001). In 18 patients (19%), FFR values were significantly lower in NIC-FFR than in ATP-FFR. In one-third of those patients (6%), it was possible to change therapeutic strategy from deferral range (>0.80) to interventional range (≦0.80) after NIC-FFR measurements. Cyclic change in FFR was smaller in NIC-FFR than in ATP-FFR (0.03±0.02 vs. 0.06±0.05, p<0.0001).
  
  
  
  Additional IC NIC might be useful to confirm sufficient maximum hyperemia after IV ATP infusion in daily clinical practice. Furthermore, IC NIC could reduce cyclic change in FFR; thus, physicians might find it easier to determine FFR value during the procedure.
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Takami
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. Electronic address: s-sonoda@med.uoeh-u.ac.jp.
authors.forename: Shinjo
authors.initials: S
authors.lastname: Sonoda
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Muraoka
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Sanuki
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Kuninobu
authors.initials: K
authors.lastname: Kashiyama
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oginosawa
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tsuda
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Araki
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
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*; D006801:Humans; D007262:Infusions, Intravenous; D007564:Japan; D008297:Male; D020108:Nicorandil / Q000008:administration & dosage*; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D020108:Nicorandil; D000255:Adenosine Triphosphate
keywords: Adenosine 5′-triphosphate; Caffeine; Cyclic change; Fractional flow reserve; Nicorandil