Additive value of nicorandil on ATP for further inducing hyperemia in patients with an intermediate coronary artery stenosis
| Autor: | Kiyoshi Yoshida, Yoji Neishi, Shiro Uemura, Tomitaka Higa, Yuhei Kobayashi, Yukari Kobayashi, Hiroyuki Okura |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Cardiac Catheterization Vasodilator Agents Hyperemia Fractional flow reserve 030204 cardiovascular system & hematology Severity of Illness Index Cardiac Catheters 03 medical and health sciences 0302 clinical medicine Adenosine Triphosphate Predictive Value of Tests Internal medicine Severity of illness medicine Transducers Pressure Humans 030212 general & internal medicine Prospective Studies Adverse effect Nicorandil Prospective cohort study Infusions Intravenous Aged Chi-Square Distribution business.industry Coronary Stenosis General Medicine Middle Aged Adenosine Fractional Flow Reserve Myocardial medicine.anatomical_structure Predictive value of tests Injections Intravenous cardiovascular system Cardiology Linear Models Female Cardiology and Cardiovascular Medicine business medicine.drug Artery |
| Zdroj: | Coronary artery disease. 28(2) |
| ISSN: | 1473-5830 |
| Popis: | The induction of hyperemia is of importance to precisely assess the functional significance of coronary artery lesions with fractional flow reserve (FFR). Adenosine or ATP alone is used widely in this setting; however, little is known about the additive value of nicorandil, which acts as a nitrate and a K-ATP channel opener, to induce further hyperemia.A total of 183 intermediate native coronary artery lesions from 112 patients were prospectively enrolled into this study. FFR was measured using a coronary pressure wire during an intravenous ATP infusion alone (150 mcg/kg/min) (FFRATP) and repeated after an adjunctive intracoronary nicorandil injection (2.0 mg) (FFRATP+Nico).Physiologic measurements were completed without any severe adverse effects from ATP and nicorandil in all patients. FFRATP and FFRATP+Nico had a strong linear correlation (R=0.79, P0.001). The FFR value became significantly lower with an adjunctive intracoronary nicorandil injection compared with ATP alone [FFRATP vs. FFRATP+Nico, 0.87 (interquartile range: 0.81-0.92) vs. 0.85 (0.79-0.90), P0.001]. A total of 18 lesions out of 183 (9.8%) were reclassified after a nicorandil injection (12 from FFR0.80 to ≤0.80 vs. six from FFR≤0.80 to0.80, P=0.26). The adjunctive effect of nicorandil was accentuated with each increment of FFRATP strata (per 0.05 increase, P for trend0.001), but with minimal effect around the borderline FFR zone.An adjunctive intracoronary nicorandil injection is safe, but appears to have little effect in inducing further hyperemia. Therefore, its effect on the clinical scenario is limited. |
| Databáze: | OpenAIRE |
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