Utility and Validity of Intracoronary Administration of Nicorandil Alone for the Measurement of Fractional Flow Reserve in Patients With Intermediate Coronary Stenosis

• DOI: 10.1253/circj.cj-19-0421
• Publication Date: 2019-08-13T22:02:51Z
• Authors: Kasumi Ishibuchi; Kenichi Fujii; Satoru Otsuji; Shin Takiuchi; Katsuyuki Hasegawa; Hiroto Tamaru; Rui Ishii; Shingo Yasuda; Sho Nakabayashi; Wataru Yamamoto; Hirofumi Kusumoto; Yusuke Taniguchi; Mikio Kakishita; Yuji Shimatani; Yorihiko Higashino
• Keywords: Adult; Aged, 80 and over; Male; Cardiac Catheterization; Coronary Stenosis; Reproducibility of Results; Hyperemia; Middle Aged; Coronary Angiography; Coronary Vessels; Angina Pectoris; 3. Good health; Fractional Flow Reserve, Myocardial; Nicorandil; 03 medical and health sciences; Adenosine Triphosphate; 0302 clinical medicine; Predictive Value of Tests; Humans; Female; Prospective Studies; Infusions, Intravenous; Aged

Intracoronary (IC) administration of nicorandil has been proposed as an alternative choice of hyperemic agent for fractional flow reserve (FFR) measurements. This study evaluated the utility and validity of IC nicorandil administration alone to induce maximal hyperemia.Methods and Results:Two-hundred-seven patients with coronary artery disease listed for coronary angiography with FFR were prospectively enrolled. FFR was measured after (1) IC administration of nicorandil 2 mg (ICNIC2 mg); (2) continuous intravenous (IV) adenosine triphosphatase (ATP) infusion at 150 μg/kg/min (IVATP150); (3) IV ATP infusion at 210 μg/kg/min (IVATP210); (4) IC administration of 0.5 mg nicorandil during IVATP150 (ICNIC0.5 mg+IVATP150); (5) IC administration of 1 mg nicorandil during IVATP150 (ICNIC1 mg+IVATP150); and (6) IC administration of 2 mg nicorandil during IVATP150 (ICNIC2 mg+IVATP150). The average FFR values and the rate of achieving maximum hyperemia after ICNIC2 mg, IVATP150, IVATP210, ICNIC0.5 mg+IVATP150, ICNIC1 mg+IVATP150, and ICNIC2 mg+IVATP150 were 0.85±0.08, 0.89±0.08, 0.85±0.09, 0.84±0.08, 0.83±0.08, 0.83±0.08 (P<0.01), and 92%, 54%, 91%, 96%, 99%, 99% (P<0.01), respectively. The incidence of systolic aortic pressure drop, chest discomfort, and transient atrioventricular block increased in a dose-dependent manner after IV ATP infusion, but almost no adverse effects were observed after ICNIC2 mg.ICNIC2 mg produced a more pronounced hyperemia than continuous IV ATP, and might be the preferred method for assessment of FFR.