Tanaka Nobukiyo, Takahashi Yuya, Ishihara Hiroki, Kawakami Tohru, Ono Hiroyoshi
Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan.
Clin Cardiol. 2015 Jan;38(1):20-4. doi: 10.1002/clc.22344.
Fractional flow reserve (FFR) is useful for determining the functional significance of epicardial coronary stenosis and may facilitate clinical decision making in patients with an equivocal coronary stenosis for coronary revascularization. Therefore, determining an efficient and safe method to achieve hyperemia is important for evaluating FFR. We investigated the usefulness and safety of intracoronary bolus administration of nicorandil compared with intravenous administration of adenosine triphosphate (ATP) for evaluating FFR in Japanese patients with suspected angina pectoris.
First, we evaluated the most appropriate hyperemic dose of nicorandil in the first 11 consecutive patients out of 101 Japanese patients. Next, we compared the FFR induced by ATP and by 2 mg of nicorandil in 130 vessels of the 101 patients.
FFR was measured according to nicorandil dose in 14 vessels among 11 of the 101 patients; 92.9% of the patients achieved hyperemia with 2 mg of nicorandil. The FFR values obtained with ATP were significantly correlated with those obtained with 2 mg of nicorandil (regression coefficient = 0.974, R(2) = 0.933, P < 0.001). There were no hypotension cases needing a vasopressor after ATP or nicorandil administration, and there was 1 case of transient second-degree atrioventricular block after ATP administration. The time taken to achieve hyperemia after nicorandil administration (18.9 ± 9.6 seconds) was significantly shorter than that after ATP administration (197.9 ± 23.8 seconds) (P < 0.001).
Intracoronary nicorandil administration is more useful than and as safe as intravenous administration of ATP for evaluating FFR in Japanese patients.
血流储备分数（FFR）有助于确定心外膜冠状动脉狭窄的功能意义，并且可能有助于对冠状动脉狭窄情况不明确的患者进行冠状动脉血运重建的临床决策。因此，确定一种有效且安全的实现充血的方法对于评估FFR很重要。我们研究了在日本疑似心绞痛患者中，与静脉注射三磷酸腺苷（ATP）相比，冠状动脉内推注尼可地尔用于评估FFR的有效性和安全性。
首先，我们在101例日本患者中的连续11例患者中评估了尼可地尔最合适的充血剂量。接下来，我们比较了101例患者的130条血管中ATP和2mg尼可地尔诱导的FFR。
在101例患者中的11例患者的14条血管中根据尼可地尔剂量测量了FFR；92.9%的患者使用2mg尼可地尔实现了充血。ATP获得的FFR值与2mg尼可地尔获得的FFR值显著相关（回归系数 = 0.974，R² = 0.933，P < 0.001）。在给予ATP或尼可地尔后，没有需要血管升压药的低血压病例，并且在给予ATP后有1例短暂性二度房室传导阻滞。给予尼可地尔后达到充血的时间（18.9±9.6秒）明显短于给予ATP后的时间（197.9±23.8秒）（P < 0.001）。
在日本患者中，冠状动脉内给予尼可地尔在评估FFR方面比静脉注射ATP更有用且同样安全。
