Jong Chien-Boon, Liao Min-Tsun, Lu Tsui-Shan, Meng Shih-Wei, Chen Chun-Kai, Tsai Ya-Chin, Kuo Jui-Cheng, Wu Chih-Cheng
Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu.
College of Medicine, National Taiwan University.
Acta Cardiol Sin. 2022 Sep;38(5):553-563. doi: 10.6515/ACS.202209_38(5).20220309A.
The recommended dosage of intracoronary adenosine in fractional flow reserve (FFR) assessment is controversial. High-dose adenosine may overcome the biological variability of adenosine response in hyperemia.
We aimed to test the efficacy and safety of a high-dose escalation protocol at our institute.
Using the adenosine dose escalation protocol, the percentages of FFR ≤ 0.75 and 0.80 after high-dose escalation were compared with those at conventional doses. The chi-squared test was used to evaluate the accuracy of FFR values with the tested doses by comparing them with the results of a non-invasive pretest.
A total of 87 patients (130 vessels) were included, and protocol adherence was 93.1%. High-dose intracoronary adenosine was injected in 78.5% of the vessels. The dose escalation strategy was well-tolerated without serious complications. The positive rate increased significantly after conducting the protocol compared to that with a conventional dose (28.2% vs. 23.6% with an FFR threshold of 0.75, and 48.7% vs. 42.5% with a threshold of 0.80, both p < 0.05). In the validation cohort, only FFR ≤ 0.75 was associated with the binary result of the non-invasive pretest (p < 0.01 vs. p = 0.37). The high-dose adenosine escalation strategy did not increase the accuracy of FFR (77.8% vs. 75.6% in conventional dose and high-dose adenosine, respectively).
The use of a high-dose escalation strategy increased the positive rate in FFR assessments.
冠状动脉内注射腺苷用于血流储备分数（FFR）评估时的推荐剂量存在争议。高剂量腺苷可能克服充血状态下腺苷反应的生物学变异性。
我们旨在测试我院高剂量递增方案的有效性和安全性。
采用腺苷剂量递增方案，将高剂量递增后FFR≤0.75和0.80的百分比与传统剂量下的百分比进行比较。通过卡方检验，将测试剂量下FFR值的准确性与无创预测试结果进行比较来评估。
共纳入87例患者（130支血管），方案依从率为93.1%。78.5%的血管注射了高剂量冠状动脉内腺苷。剂量递增策略耐受性良好，无严重并发症。与传统剂量相比，实施该方案后阳性率显著提高（FFR阈值为0.75时，分别为28.2%对23.6%；阈值为0.80时，分别为48.7%对42.5%，均p<0.05）。在验证队列中，只有FFR≤0.75与无创预测试的二元结果相关（p<0.01对p = 0.37）。高剂量腺苷递增策略未提高FFR的准确性（传统剂量和高剂量腺苷分别为77.8%对75.6%）。
高剂量递增策略的使用提高了FFR评估的阳性率。
