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Effects of intravenous and intracoronary adenosine 5'-triphosphate as compared with adenosine on coronary flow and

A Jeremias1, S D Filardo, R J Whitbourn

  • 1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Circulation
|January 25, 2000
PubMed

Insights

Adenosine triphosphate (ATP) is equivalent to adenosine for assessing coronary stenosis via coronary flow reserve (CFR) and fractional flow reserve (FFR). However, neither drug induces maximal hyperemia compared to complete coronary occlusion.

Area of Science:

  • Cardiovascular physiology
  • Interventional cardiology
  • Pharmacology

Background:

  • Coronary flow reserve (CFR) and fractional flow reserve (FFR) measurements require maximal hyperemia.
  • Adenosine is the standard hyperemia-inducing agent but has drawbacks like cost and tolerability.

Purpose of the Study:

  • To evaluate adenosine triphosphate (ATP) as an alternative to adenosine for inducing hyperemia.
  • To compare the efficacy of ATP and adenosine in CFR and FFR measurements.

Main Methods:

  • Equivalency testing of ATP and adenosine in canines and human stenoses.
  • Measurements of CFR and FFR using intracoronary ATP, adenosine, and coronary occlusion.
  • Dosage-response assessment for both agents.

Main Results:

  • Both ATP and adenosine significantly increased CFR and FFR, with higher doses yielding greater hyperemia.
  • ATP and adenosine demonstrated excellent linear correlation for CFR (R=0.934) and FFR (R=0.985).
  • Hyperemic response to ATP and adenosine was less than that achieved by coronary occlusion.

Conclusions:

  • Increased dosages of ATP and adenosine enhance coronary hyperemia beyond standard clinical recommendations.
  • ATP is therapeutically equivalent to adenosine for CFR and FFR assessment.
  • Neither pharmacological agent achieved maximal hyperemia; coronary occlusion provided a superior hyperemic response.
Abstract

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