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 Vannesa, McConnachie Alex, Curzen Nick, Oldroyd Keith G, Berry Colin
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
Int J Cardiol. 2016 Jan 1;202:305-10. doi: 10.1016/j.ijcard.2015.09.014. Epub 2015 Sep 18.
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.
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.
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.
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.
基于冠状动脉导丝的充血状态下诊断评估可能会导致医源性并发症。我们评估了在急性冠状动脉综合征患者中使用静脉注射腺苷基于导丝测量冠状动脉生理功能的安全性。
我们在6个中心同时开展的两项研究中前瞻性纳入了接受侵入性治疗的ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）患者（NCT01764334；NCT02072850）。所有参与者均接受了使用静脉注射腺苷（140μg/kg/分钟）输注1-2分钟的诊断性冠状动脉导丝研究。对患者发生严重不良事件（SAEs）的情况进行前瞻性评估，并记录症状以及侵入性测量的血流动力学指标。
2011年3月至2013年5月期间纳入了648例患者（1家医院的298例STEMI患者；再灌注平均时间253分钟；6家医院的350例NSTEMI患者；从首次胸痛发作至血管造影的中位时间为3（2，5）天）。两名NSTEMI患者（总体发生率0.3%）发生了与导丝相关的冠状动脉夹层。STEMI患者未发生导丝夹层。大多数患者（86%）在腺苷输注期间报告有胸部症状。腺苷输注期间未发生严重不良事件，且所有症状在输注停止后均缓解。
在这项多中心分析中，在STEMI或NSTEMI患者中使用静脉注射腺苷基于导丝测量血流储备分数（FFR）和微循环阻力（IMR）是安全的。自限性症状很常见，但与严重不良事件无关。最后，注意到STEMI和NSTEMI患者中的冠状动脉夹层是一种罕见现象。
