Safety of guidewire-based measurement of fractional flow reserve and the index of microvascular resistance using intravenous adenosine in patients with acute or recent myocardial infarction

Nadeem Ahmed, Jamie Layland, David Carrick, Mark C. Petrie, Margaret McEntegart, Hany Eteiba, Stuart Hood, Mitchell Lindsay, Stuart Watkins, Andrew Davie, Ahmed Mahrous, Jaclyn Carberry, Vannesa Teng, Alex McConnachie, Nick Curzen, Keith G. Oldroyd, Colin Berry

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Abstract

Aims: Coronary guidewire-based diagnostic assessments with hyperemia may cause iatrogenic complications. We assessed the safety of guidewire-based measurement of coronary physiology, using intravenous adenosine, in patients with an acute coronary syndrome. Methods: We prospectively enrolled invasively managed STEMI and NSTEMI patients in two simultaneously conducted studies in 6 centers (NCT01764334; NCT02072850). All of the participants underwent a diagnostic coronary guidewire study using intravenous adenosine (140 μg/kg/min) infusion for 1-2 min. The patients were prospectively assessed for the occurrence of serious adverse events (SAEs) and symptoms and invasively measured hemodynamics were also recorded. Results: 648 patients (n = 298 STEMI patients in 1 hospital; mean time to reperfusion 253 min; n = 350 NSTEMI in 6 hospitals; median time to angiography from index chest pain episode 3 (2, 5) days) were included between March 2011 and May 2013. Two NSTEMI patients (0.3% overall) experienced a coronary dissection related to the guidewire. No guidewire dissections occurred in the STEMI patients. Chest symptoms were reported in the majority (86%) of patient's symptoms during the adenosine infusion. No serious adverse events occurred during infusion of adenosine and all of the symptoms resolved after the infusion ceased. Conclusions: In this multicenter analysis, guidewire-based measurement of FFR and IMR using intravenous adenosine was safe in patients following STEMI or NSTEMI. Self-limiting symptoms were common but not associated with serious adverse events. Finally, coronary dissection in STEMI and NSTEMI patients was noted to be a rare phenomenon.

Original languageEnglish
Pages (from-to)305-310
Number of pages6
JournalInternational Journal of Cardiology
Volume202
DOIs
Publication statusPublished - 1 Jan 2016
Externally publishedYes

Keywords

  • Adenosine
  • Blood pressure (BP)
  • Heart rate (HR)
  • Non ST-elevation myocardial infarction (NSTEMI)
  • Percutaneous coronary intervention (PCI)
  • ST-elevation myocardial infarction (STEMI)

Cite this

Ahmed, N., Layland, J., Carrick, D., Petrie, M. C., McEntegart, M., Eteiba, H., Hood, S., Lindsay, M., Watkins, S., Davie, A., Mahrous, A., Carberry, J., Teng, V., McConnachie, A., Curzen, N., Oldroyd, K. G., & Berry, C. (2016). Safety of guidewire-based measurement of fractional flow reserve and the index of microvascular resistance using intravenous adenosine in patients with acute or recent myocardial infarction. International Journal of Cardiology, 202, 305-310. https://doi.org/10.1016/j.ijcard.2015.09.014