Safety of guidewire-based measurement of fractional flow reserve and the index of microvascular resistance using intravenous adenosine in patients with acute or recent myocardial infarction

Nadeem Ahmed, Jamie Layland, David Carrick, Mark C Petrie, Margaret McEntegart, Hany Eteiba, Stuart Hood, Mitchell Lindsay, Stuart Watkins, Andrew Davie, Ahmed Mahrous, Jaclyn Carberry, Vannesa Teng, Alex McConnachie, Nick Curzen, Keith G Oldroyd, Colin Berry, Nadeem Ahmed, Jamie Layland, David Carrick, Mark C Petrie, Margaret McEntegart, Hany Eteiba, Stuart Hood, Mitchell Lindsay, Stuart Watkins, Andrew Davie, Ahmed Mahrous, Jaclyn Carberry, Vannesa Teng, Alex McConnachie, Nick Curzen, Keith G Oldroyd, Colin Berry

Abstract

Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Adenosine; Blood pressure (BP); Heart rate (HR); Non ST-elevation myocardial infarction (NSTEMI); Percutaneous coronary intervention (PCI); ST-elevation myocardial infarction (STEMI).

Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
A hemodynamic recording obtained from a diagnostic pressure- and temperature-sensitive guidewire (PressureWire Certus™, St. Jude Medical, Mn.) located in a culprit coronary artery at the end of primary PCI. The blue arrow represents the thermodilution recordings during resting conditions before adenosine administration. The thermodilution curve represents the transit time for the change in temperature detected by the distal guidewire thermistor following intra-coronary bolus injection of saline (room temperature) via the guiding catheter. The subsequent yellow arrow represents the transit times for thermodilution curves following intra-coronary injections of saline during hyperemia with adenosine (140 μg/kg/min). During hyperemia, there is evidence of a reduction in arterial blood pressure depicted by the yellow arrow, reflecting the typical hemodynamic response in the systemic and coronary circulations to intravenous adenosine. Hemodynamic recordings were assessed with vendor software (RADIView Version 2.2, St Jude Medical, Mn.). The systolic blood pressure and diastolic blood pressure during at least 3 cardiac cycles in steady-state conditions at rest and during hyperemia were assessed.

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