Presumed Fatal Bronchospasm From Adenosine Administered for Assessment of Fractional Flow Reserve

Adenosine is a commonly used vasodilating agent to induce hyperemia in fractional flow reserve. Most side effects are transient and self-limiting because of its short half-life.

A 79-year-old man with known airway disease underwent coronary angiography for unstable angina. A moderate-to-severe lesion was found in the proximal left anterior descending artery. Pressure wire assessment was undertaken and intravenous adenosine was administered. This resulted in severe bronchospasm progressing to respiratory arrest. Despite resuscitation attempts, the patient did not survive.

Although bronchospasm is a recognized adverse reaction to adenosine, to our knowledge there have been no prior reports of presumed fatal adenosine-associated bronchospasm during fractional flow reserve testing.

Although extremely rare, adenosine carries a risk of fatal bronchospasm, and alternative hyperemic agents or nonhyperemic physiological indices should be used preferentially in patients with known obstructive airway disease. Aminophylline should be immediately available in all clinical settings where adenosine is administered frequently.