AUTHOR=Yang Xia , Yu Qiang , Yang Junjie , Guo Jun , Jin Qinhua 

TITLE=Intracoronary nicorandil induced hyperemia for physiological assessments in the coronary artery lesions

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1023641

DOI=10.3389/fcvm.2022.1023641

ISSN=2297-055X

ABSTRACT=<sec><title>Objective</title><p>Maximal hyperemia is a key element of invasive physiological examination. The aim of this study was to investigate the efficacy and safety of intracoronary (IC) nicorandil in comparison with adenosine 5′-triphosphate (ATP) intravenous (i.v.) injection for fractional flow reserve (FFR) measurement in coronary artery lesions.</p></sec><sec><title>Materials and methods</title><p>In this study, 46 patients who had their FFR measured were enrolled, including 51 lesions. Hyperemia was induced by bolus 2 mg nicorandil and ATP (40 mg ATP + 36 ml saline, weight × 10 ml/h) for FFR measurement. The safety and efficacy of IC nicorandil were evaluated.</p></sec><sec><title>Results</title><p>The mean FFR values measured by nicorandil and ATP were 0.810 ± 0.013 and 0.799 ± 0.099, <italic>p</italic> &lt; 0.001, respectively. There was a strong correlation between FFR measured by nicorandil and ATP (<italic>r</italic> = 0.983, <italic>R</italic><sup>2</sup> = 0.966, FFR<sub>nicorandil</sub> = 0.937 × FFR<sub>ATP</sub> + 0.061). The rate of FFR ≤ 0.75 in the nicorandil and ATP groups was 31.37 vs. 35.29%, respectively (<italic>p</italic> = 0.841), the consistency rate was 96.08%; the FFR ≤ 0.8 rate was 41.18 and 43.14%, respectively (<italic>p</italic> = 0.674), and the consistency rate was 90.20%. In five lesions, the FFR value measured by nicorandil ranged between 0.79 and 0.82, indicating inconsistency according to FFR ≤ 0.8. The blood pressure changes caused by nicorandil and ATP were 12.96 ± 6.83 and 22.22 ± 11.44 mmHg (<italic>p</italic> &lt; 0.001); the heart rate changes were 2.43 ± 1.31 and 6.52 ± 2.87 beats/min, respectively (<italic>p</italic> &lt; 0.001); and the PR interval changes were 6.0 (1.0–11.0) and 9.0 (2.0–19.0) ms, respectively (<italic>p</italic> &lt; 0.001). Visual analog scale (VAS) scores in the nicorandil group were all in the range 0–2, while in the ATP group were mostly in the range of 3–5.</p></sec><sec><title>Conclusion</title><p>Intracoronary bolus of nicorandil (2 mg) infusion induces stable hyperemia, and it could be considered as an alternative drug to ATP for FFR measurement with a lower side effect profile in most patients.</p></sec>