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Individual Lesion-Level Meta-Analysis Comparing Various Doses of Intracoronary Bolus Injection of Adenosine With
Gilbert W M Wijntjens1, Ellen L van Uffelen1, Mauro Echavarría-Pinto2
1Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands.
Insights
Intracoronary adenosine bolus injection is a safe and effective alternative to intravenous infusion for fractional flow reserve (FFR) assessment. This meta-analysis confirms minimal clinical differences, supporting its use in FFR evaluations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Intravenous adenosine infusion is standard for fractional flow reserve (FFR) assessment but causes adverse effects and is time-consuming.
- Intracoronary adenosine bolus injection offers a patient-friendly, cost-effective, and faster alternative.
- Existing literature on intracoronary vs. intravenous adenosine equivalence for FFR is limited.
Purpose of the Study:
- To compare intracoronary adenosine bolus injection with intravenous adenosine infusion for FFR assessment.
- To evaluate the equivalence and clinical relevance of FFR values obtained by both methods.
- To analyze the impact of intracoronary adenosine dosage on FFR measurements.
Main Methods:
- A lesion-level meta-analysis was conducted, including 16 studies with 1972 FFR measurements (1413 lesions).
- Data were collected from published studies and direct author contact or scatterplot digitization.
- Intracoronary adenosine doses were categorized as low (<40 µg), intermediate (40-99 µg), and high (≥100 µg).
Main Results:
- A strong correlation (r=0.915, P<0.001) was found between intracoronary and intravenous FFR.
- Mean FFR values were identical (0.81±0.11) for both methods (P<0.001).
- The mean difference between intracoronary and intravenous FFR was clinically insignificant (0.006; 95% CI: -0.066 to 0.078).
Conclusions:
- Intracoronary adenosine administration yields FFR values comparable to the intravenous route.
- The observed differences between intracoronary and intravenous adenosine for FFR are not clinically relevant.
- Intracoronary adenosine represents a practical and well-tolerated alternative for FFR assessment.
Background:
Intravenous infusion of adenosine is considered standard practice for fractional flow reserve (FFR) assessment but is associated with adverse side-effects and is time-consuming. Intracoronary bolus injection of adenosine is better tolerated by patients, cheaper, and less time-consuming. However, current literature remains fragmented and modestly sized regarding the equivalence of intracoronary versus intravenous adenosine. We aim to investigate the relationship between intracoronary adenosine and intravenous adenosine to determine FFR.
Methods:
We performed a lesion-level meta-analysis to compare intracoronary adenosine with intravenous adenosine (140 µg/kg per minute) for FFR assessment. The search was conducted in accordance to the Preferred Reporting for Systematic Reviews and Meta-Analysis statement. Lesion-level data were obtained by contacting the respective authors or by digitization of scatterplots using custom-made software. Intracoronary adenosine dose was defined as; low: <40 µg, intermediate: 40 to 99 µg, and high: ≥100 µg.
Results:
We collected 1972 FFR measurements (1413 lesions) comparing intracoronary with intravenous adenosine from 16 studies. There was a strong correlation (correlation coefficient =0.915; P<0.001) between intracoronary-FFR and intravenous-FFR. Mean FFR was 0.81±0.11 for intracoronary adenosine and 0.81±0.11 for intravenous adenosine (P<0.001). We documented a nonclinically relevant mean difference of 0.006 (limits of agreement: -0.066 to 0.078) between the methods. When stratified by the intracoronary adenosine dose, mean differences between intracoronary and intravenous-FFR amounted to 0.004, 0.011, or 0.000 FFR units for low-dose, intermediate-dose, and high-dose intracoronary adenosine, respectively.
Conclusions:
The present study documents clinically irrelevant differences in FFR values obtained with intracoronary versus intravenous adenosine. Intracoronary adenosine hence confers a practical and patient-friendly alternative for intravenous adenosine for FFR assessment.
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