Pooled comparison of regadenoson versus adenosine for measuring fractional flow reserve and coronary flow in the catheterization laboratory.

Abstract

BACKGROUND:

Adenosine is the gold standard for augmenting coronary flow during fractional flow reserve (FFR) testing of intermediate coronary stenoses. However, intravenous infusion is time-consuming and intracoronary injection is subject to variability. Regadenoson is a newer adenosine alternative administered as a single intravenous bolus during nuclear stress testing, but its efficacy and safety during FFR testing have been evaluated only in small, single-center studies.

METHODS:

We pooled data from 5 academic hospitals, in which patients undergoing clinically-indicated FFR prospectively underwent comparison of intravenous adenosine infusion (140-175mcg/kg/min) versus regadenoson bolus (400mcg). Hemodynamics and symptoms with adenosine were recorded until maximal hyperemia occurred, and after returning to baseline hemodynamics, regadenoson was administered and monitoring was repeated. In a subset of patients with coronary flow data, average peak velocity (APV) at the distal flow sensor was recorded.

RESULTS:

Of 149 patients enrolled, mean age was 59±9years, 76% were male, and 54% underwent testing of the left anterior descending artery. Mean adenosine-FFR and regadenoson-FFR were identical (0.82±0.10) with excellent correlation of individual values (r=0.96, p<0.001) and no difference in patient-reported symptoms. Four patients (2.6%) had discrepancies between the 2 drugs for the clinical decision-making cutoff of FFR≤0.80. Coronary flow responses to adenosine and regadenoson were similar (APV at maximal hyperemia 36cm/s for both, p=0.81).

CONCLUSIONS:

Regadenoson single-bolus administration has comparable FFR, symptoms, and coronary flow augmentation when compared with standard intravenous adenosine infusion. With its greater ease of administration, regadenoson may be a more "user-friendly" option for invasive ischemic testing.

• Authors: Joshua M Stolker, Michael J Lim, David M Shavelle, D Lynn Morris, Dominick J Angiolillo, Luis A Guzman, Kevin F Kennedy, Elizabeth Weber, Meena Zareh, Robert H Neumayr, Martin M Zenni
• Journal: Cardiovascular revascularization medicine : including molecular interventions (Cardiovasc Revasc Med) 2015 Jul-Aug Vol. 16 Issue 5 Pg. 266-71 ISSN: 1878-0938 [Electronic] United States
• PMID: 26242981 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Purines
• Pyrazoles
• Vasodilator Agents
• regadenoson
• Adenosine

Topics

• Adenosine (administration & dosage, therapeutic use)
• Aged
• Catheterization (methods)
• Coronary Circulation (drug effects)
• Coronary Stenosis (diagnosis)
• Coronary Vessels (drug effects)
• Female
• Fractional Flow Reserve, Myocardial (drug effects)
• Humans
• Hyperemia (drug therapy)
• Infusions, Intravenous (methods)
• Male
• Middle Aged
• Prospective Studies
• Purines (administration & dosage, therapeutic use)
• Pyrazoles (administration & dosage, therapeutic use)
• Vasodilator Agents (administration & dosage, therapeutic use)