Comparison of Effectiveness of High-Dose Intracoronary Adenosine Versus Intravenous Administration on the Assessment of Fractional Flow Reserve in Patients With Coronary Heart Disease

Intravenous adenosine is considered the drug of choice to obtain maximum hyperemia in the measurement of the fractional flow reserve (FFR). However, comparative studies performed between intravenous and intracoronary administration have not used high doses of intracoronary adenosine. The present study compared the efficacy and safety of high doses of intracoronary adenosine to intravenous administration when calculating the FFR. Intracoronary bolus doses of 60, 180, 300, and 600 mu g adenosine were compared to an intravenous administration of 140 mu g/kg/min, 200 mu g/kg/min, and 140 mu g/kg/min plus an intracoronary bolus of 120 mu g. All the cases were performed using the radial approach. FFR was assessed in 102 patients with 108 intermediate lesions by an intracoronary pressure wire. The intracoronary dose of 60 mu g was associated with a significantly, greater FFR compared to the intravenous infusion (0.02 +/- 0.03, p = 0.001). The intracoronary doses of 300 (- 0.01 +/- 0.00; p = 0.006) and 600 mu g (- 0.02 0.00; p <0.0005) were significantly associated with a smaller FFR compared to the intravenous infusion. An intracoronary dose of 600 mu g revealed a significantly greater percentage of lesions with an FFR <0.80 compared to intravenous infusion at 140 mu g/kg/min (37.6 vs 31.5%; p <0.05) and 200 mu g/kg/min (37.6 vs 32.4%; p <0.05) and compared to intracoronary doses of 60 (26.9%) and 180 mu g (31.5%). In conclusion, an intracoronary bolus dose >300 mu g can be equal to or more effective than an intravenous infusion of adenosine in achieving maximum hyperemia when calculating the FFR. Its use could simplify these procedures without having an effect on safety. (C) 2013 Elsevier Inc. All rights reserved.