Introduction.
Ischemic heart disease remains a leading cause of morbidity and mortality worldwide 1. Intermediate coronary artery lesions are responsible for about 80% of acute coronary syndromes2. Accurate assessment of the severity of intermediate coronary stenosis represents an everyday challenge for interventional cardiologists. Fractional flow reserve (FFR), which is simply derived by the ratio between distal (Pd) and proximal (Pa) pressures under conditions of maximal hyperemia, represents a reliable and reproducible tool to functionally assess the severity of coronary lesions of equivocal stenosis. Specifically, FFR has been proven to identify ischemia-inducing lesions 3–7, as well as to predict prognosis, especially when used to guide percutaneous coronary …show more content…
Using the cutoff value of 0.80, in the FAME (Fractional Flow Reserve versus Angiography for multi-vessel Evaluation) study, FFR-guided PCI has been shown to be associated with a better clinical outcome and to reduce costs compared with angiography-guided PCI in patients with multi-vessel coronary artery disease10,11 . To achieve maximal hyperemia, a vasodilator agent should be used to reduce the micro-vascular resistance. Intravenous adenosine (IV) adenosine is considered the standard method, but its use in the catheterization laboratory is time consuming and expensive. Bolus administration of intracoronary adenosine (IC) adenosine has emerged over the last decade as a promising alternative to IV adenosine in inducing maximal hyperemia12. Multiple studies have been carried out to compare the diagnostic accuracy, tolerability and costs of IV and IC adenosine administrations in intermediate coronary lesions. This systematic review and meta-analysis aims to review and provide a critical analysis of the studies that compared bolus administration of IC adenosine with reference standard continuous IV adenosine for detection of significant coronary
Ischemic heart disease remains a leading cause of morbidity and mortality worldwide 1. Intermediate coronary artery lesions are responsible for about 80% of acute coronary syndromes2. Accurate assessment of the severity of intermediate coronary stenosis represents an everyday challenge for interventional cardiologists. Fractional flow reserve (FFR), which is simply derived by the ratio between distal (Pd) and proximal (Pa) pressures under conditions of maximal hyperemia, represents a reliable and reproducible tool to functionally assess the severity of coronary lesions of equivocal stenosis. Specifically, FFR has been proven to identify ischemia-inducing lesions 3–7, as well as to predict prognosis, especially when used to guide percutaneous coronary …show more content…
Using the cutoff value of 0.80, in the FAME (Fractional Flow Reserve versus Angiography for multi-vessel Evaluation) study, FFR-guided PCI has been shown to be associated with a better clinical outcome and to reduce costs compared with angiography-guided PCI in patients with multi-vessel coronary artery disease10,11 . To achieve maximal hyperemia, a vasodilator agent should be used to reduce the micro-vascular resistance. Intravenous adenosine (IV) adenosine is considered the standard method, but its use in the catheterization laboratory is time consuming and expensive. Bolus administration of intracoronary adenosine (IC) adenosine has emerged over the last decade as a promising alternative to IV adenosine in inducing maximal hyperemia12. Multiple studies have been carried out to compare the diagnostic accuracy, tolerability and costs of IV and IC adenosine administrations in intermediate coronary lesions. This systematic review and meta-analysis aims to review and provide a critical analysis of the studies that compared bolus administration of IC adenosine with reference standard continuous IV adenosine for detection of significant coronary