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

Abstract

Background: 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,

Clinical Efficacy of Intracoronary Papaverine After Nicorandil Administration for Safe and Optimal Fractional Flow Reserve Measurement

“…Previous studies have shown that the hyperemic ability of NIC is equivalent to that of adenosine or INOUE, ET AL ATP. 14,15) Intracoronary NIC is now widely used for FFR measurements owing to the associated safety and convenience, especially in patients who consume caffeine within 24 hours or have high risks or contraindications for adenosine or ATP. 19) It has been reported that the effect of intracoronary NIC peaks at 1-2 minutes and returns to baseline 5-10 minutes after NIC administration.…”

“…13) Intracoronary NIC is widely used for FFR measurement due to the associated safety and convenience. 14,15) NIC, a potassium channel opener, markedly shortens the action potential duration in the ventricular and Purkinje fibers. Thus, NIC may prevent malignant VT development through potassium channel opening.…”

The guiding value of hybrid resting full-cycle ratio and fractional flow reserve strategy for percutaneous coronary intervention in a Chinese real-world cohort with non-ST elevation acute coronary syndrome

“…However, guidelines do not advocate FFR for patients with acute coronary syndrome (ACS) (8). Furthermore, FFR assessment needs vasodilators (such as adenosine) to reach the maximal hyperemia, and there are some disadvantages such as prolonging the operation time, increasing the examination cost, and possibly causing side effects associated with vasodilator administration (9)(10)(11), so adoption of FFR in clinical practice is still low. Previous studies have shown that the use rate of FFR is only 6-8% worldwide (12), while that in China is only 1% (13).…”

Influence of caffeine intake on intravenous adenosine-induced fractional flow reserve

“…analyzed the utility and validity of intracoronary nicorandil administration to induce maximal hyperemia in patients with coronary artery disease. Details of the study design have been reported previously [9]. Briefly, FFR was measured in six sequential steps for 210 lesions in 207 patients, as follows: (1) intracoronary administration of nicorandil 2 mg (ICNIC2mg), (2) continuous intravenous ATP infusion at 150 mg/kg/min (IVATP150), (3) intravenous ATP infusion at 210 mg/kg/min (IVATP210), (4) intracoronary administration of 0.5 mg nicorandil during IVATP150, (5) intracoronary administration of 1 mg nicorandil during IVATP150, and (6) intracoronary administration of 2 mg nicorandil during IVATP150.…”

“…Briefly, FFR was measured in six sequential steps for 210 lesions in 207 patients, as follows: (1) intracoronary administration of nicorandil 2 mg (ICNIC2mg), (2) continuous intravenous ATP infusion at 150 mg/kg/min (IVATP150), (3) intravenous ATP infusion at 210 mg/kg/min (IVATP210), (4) intracoronary administration of 0.5 mg nicorandil during IVATP150, (5) intracoronary administration of 1 mg nicorandil during IVATP150, and (6) intracoronary administration of 2 mg nicorandil during IVATP150. The inclusion and exclusion criteria have been described previously [9]. Finally, this subanalysis included 208 lesions in 205 patients.…”