Safety and efficacy of a novel hyperaemic agent, intracoronary nicorandil, for invasive physiological assessments in the cardiac catheterization laboratory

Jang, Ho-Jun; Koo, Bon Kwon; Lee, Hee Sun; Park, Jun Bean; Kim, Ji Hyun; Seo, Moo Lyong; Yang, Han Mo; Park, Kyung Woo; Nam, Chang Wook; Doh, Joon Hyung; Kim, Hyo Soo

doi:10.1093/eurheartj/eht040

Cited by 99 publications

(66 citation statements)

References 23 publications

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“…23 This may be in part because the use of adenosine in the catheterization laboratory has infrequently been associated with complications. [24][25][26] On the basis of the findings observed in our study, iFR, which allows for lesion assessment without the use of adenosine, has the potential to increase the use of physiologically guided assessment among patients with coronary artery disease, the majority of whom still undergo angiographic assessment of lesion severity.…”

Section: Discussionmentioning

confidence: 80%

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI

et al. 2017

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BACKGROUNDThe instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. METHODSWe conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure. RESULTSA primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], −1.5 to 2.8; P = 0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P = 0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure. CONCLUSIONSAmong patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was noninferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac events at 12 months. (Funded by Philips Volcano; iFR SWEDEHEART ClinicalTrials.gov number, NCT02166736.) a bs tr ac t

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Section: Discussionmentioning

confidence: 80%

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI

et al. 2017

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“…[16][17][18][19] Current guidelines recommend intravenous infusion of adenosine at a rate of 140 μg/kg per minute to determine FFR of intermediate coronary artery stenosis. 2,20,21 Intracoronary application of adenosine is a possible alternative, but the optimal dose has not been clarified and intracoronary bolus injection has not been systematically compared with intravenous administration on a large scale.…”

Section: Ffr-guided Percutaneous Coronary Intervention Represents An mentioning

confidence: 99%

Comparison of Intracoronary Versus Intravenous Administration of Adenosine for Measurement of Coronary Fractional Flow Reserve

Schlundt

Bietau

Klinghammer

et al. 2015

Circ: Cardiovascular Interventions

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“…regadenoson (agonist of adenosine receptor A2A) [25], i.c. sodium nitroprusside [26], nicorandil [27], nitrates [28] and papaverine [17,29]. It is important to note that these substances are much less frequently used and thus, do not often appear in the protocols for large RCTs.…”

Section: Additional Aspects Of Ffr Measurement In Patients Presentingmentioning

confidence: 99%

Fractional flow reserve (FFR)-based therapy in patients presenting with acute coronary syndrome: Current data and everyday practice

Żuk¹,

Ciećwierz²,

Cwalina³

et al. 2017

Cardiol J

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Safety and efficacy of a novel hyperaemic agent, intracoronary nicorandil, for invasive physiological assessments in the cardiac catheterization laboratory

Abstract: This study suggests that IC bolus injection of nicorandil is a simple, safe, and effective way to induce steady-state hyperaemia for invasive physiological evaluations. Clinicaltrials.gov number: NCT01331902.

Cited by 99 publications

References 23 publications

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI

Comparison of Intracoronary Versus Intravenous Administration of Adenosine for Measurement of Coronary Fractional Flow Reserve

Fractional flow reserve (FFR)-based therapy in patients presenting with acute coronary syndrome: Current data and everyday practice

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