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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

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
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
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 ?g/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 (0.03% 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.
adenosine, ST-elevation myocardial infarction (STEMI), non ST-elevation myocardial infarction (NSTEMI), percutaneous coronary intervention (PCI), blood pressure (BP), heart rate (HR)
0167-5273
1-37
Ahmed, Nadeem
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Layland, Jamie
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Carrick, David
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Petrie, Mark C.
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McEntegart, Margaret
c663c90a-2511-4c90-87eb-0ac05d9ad464
Eteiba, Hany
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Hood, Stuart
b9ceca2f-d725-435e-9755-d8166e67df7b
Lindsay, Mitchell
b175e163-4db8-4787-a7d1-b42554b034d0
Watkins, Stuart
0b6d0a61-ae26-43f0-a06d-404cc110f333
Davie, Andrew
afd81ce4-c460-452e-b4fb-c74adcdd8d4a
Mahrous, Ahmed
d8761b9e-7f20-40cf-a19d-4ed2f4c97460
Carberry, Jaclyn
931db023-ae6d-45f1-8bbb-702cafa04df1
Teng, Vanessa Yue
1174769e-f9b4-4667-9dda-5d392c35c049
McConnachie, Alex
c930d8cf-ab00-47e9-a22d-dbcf7a26f039
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Oldroyd, Keith G.
536fd60e-50d0-4a76-a818-ab6b2b03567f
Berry, Colin
106fbcaa-69ba-45ec-969f-6f18e06680cf
Ahmed, Nadeem
52374ea1-0d36-4c46-91ee-0004566e1fa3
Layland, Jamie
ff4df265-fcd1-4cec-a947-ff56f34ac59a
Carrick, David
2ea45d1f-df41-44c7-b12b-2dd6f0b5f530
Petrie, Mark C.
f53b1a39-14d9-41ab-a384-6cc78f32183b
McEntegart, Margaret
c663c90a-2511-4c90-87eb-0ac05d9ad464
Eteiba, Hany
4f08065f-3547-412a-83c9-3f5b37777745
Hood, Stuart
b9ceca2f-d725-435e-9755-d8166e67df7b
Lindsay, Mitchell
b175e163-4db8-4787-a7d1-b42554b034d0
Watkins, Stuart
0b6d0a61-ae26-43f0-a06d-404cc110f333
Davie, Andrew
afd81ce4-c460-452e-b4fb-c74adcdd8d4a
Mahrous, Ahmed
d8761b9e-7f20-40cf-a19d-4ed2f4c97460
Carberry, Jaclyn
931db023-ae6d-45f1-8bbb-702cafa04df1
Teng, Vanessa Yue
1174769e-f9b4-4667-9dda-5d392c35c049
McConnachie, Alex
c930d8cf-ab00-47e9-a22d-dbcf7a26f039
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Oldroyd, Keith G.
536fd60e-50d0-4a76-a818-ab6b2b03567f
Berry, Colin
106fbcaa-69ba-45ec-969f-6f18e06680cf

Ahmed, Nadeem, Layland, Jamie, Carrick, David, Petrie, Mark C., McEntegart, Margaret, Eteiba, Hany, Hood, Stuart, Lindsay, Mitchell, Watkins, Stuart, Davie, Andrew, Mahrous, Ahmed, Carberry, Jaclyn, Teng, Vanessa Yue, McConnachie, Alex, Curzen, Nick, Oldroyd, Keith G. and Berry, Colin (2015) 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, 1-37. (doi:10.1016/j.ijcard.2015.09.014).

Record type: Article

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 ?g/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 (0.03% 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.

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Accepted/In Press date: 14 September 2015
e-pub ahead of print date: 18 September 2015
Keywords: adenosine, ST-elevation myocardial infarction (STEMI), non ST-elevation myocardial infarction (NSTEMI), percutaneous coronary intervention (PCI), blood pressure (BP), heart rate (HR)
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 381797
URI: http://eprints.soton.ac.uk/id/eprint/381797
ISSN: 0167-5273
PURE UUID: 56a08c0c-3c08-4154-9ae8-c8fbed1f82b2

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Date deposited: 22 Sep 2015 16:01
Last modified: 16 Dec 2019 20:14

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Contributors

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

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