Yang Xia, Yu Qiang, Yang Junjie, Guo Jun, Jin Qinhua
Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Front Cardiovasc Med. 2022 Nov 2;9:1023641. doi: 10.3389/fcvm.2022.1023641. eCollection 2022.
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.
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.
The mean FFR values measured by nicorandil and ATP were 0.810 ± 0.013 and 0.799 ± 0.099, < 0.001, respectively. There was a strong correlation between FFR measured by nicorandil and ATP ( = 0.983, = 0.966, FFR = 0.937 × FFR + 0.061). The rate of FFR ≤ 0.75 in the nicorandil and ATP groups was 31.37 vs. 35.29%, respectively ( = 0.841), the consistency rate was 96.08%; the FFR ≤ 0.8 rate was 41.18 and 43.14%, respectively ( = 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 ( < 0.001); the heart rate changes were 2.43 ± 1.31 and 6.52 ± 2.87 beats/min, respectively ( < 0.001); and the PR interval changes were 6.0 (1.0-11.0) and 9.0 (2.0-19.0) ms, respectively ( < 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.
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.
最大充血是有创生理检查的关键要素。本研究旨在比较冠状动脉内（IC）尼可地尔与静脉注射（i.v.）5'-三磷酸腺苷（ATP）在测量冠状动脉病变血流储备分数（FFR）方面的有效性和安全性。
本研究纳入了46例接受FFR测量的患者，共51处病变。通过静脉推注2mg尼可地尔和ATP（40mg ATP + 36ml生理盐水，按体重×10ml/h）诱导充血以进行FFR测量。评估了冠状动脉内注射尼可地尔的安全性和有效性。
尼可地尔和ATP测量的平均FFR值分别为0.810±0.013和0.799±0.099，P<0.001。尼可地尔和ATP测量的FFR之间存在强相关性（r = 0.983，r² = 0.966，FFR尼可地尔 = 0.937×FFRATP + 0.061）。尼可地尔组和ATP组FFR≤0.75的发生率分别为31.37%和35.29%（P = 0.841），一致性率为96.08%；FFR≤0.8的发生率分别为41.18%和43.14%（P = 0.674），一致性率为90.20%。在5处病变中，尼可地尔测量的FFR值在0.79至0.82之间，根据FFR≤0.8表明存在不一致。尼可地尔和ATP引起的血压变化分别为12.96±6.83和22.22±11.44mmHg（P<0.001）；心率变化分别为2.43±1.31和6.52±2.87次/分钟（P<0.001）；PR间期变化分别为6.0（1.0 - 11.0）和9.0（2.0 - 19.0）ms（P<0.001）。尼可地尔组的视觉模拟量表（VAS）评分均在0 - 2范围内，而ATP组大多在3 - 5范围内。
冠状动脉内推注尼可地尔（2mg）输注可诱导稳定的充血，在大多数患者中，它可被视为测量FFR时替代ATP的药物，且副作用较小。
