BACKGROUND Intravenous infusion of adenosine is considered standard practice for fractional flow reserve (FFR) assessment but is associated with adverse side-effects and is time-consuming. Intracoronary bolus injection of adenosine is better tolerated by patients, cheaper, and less time-consuming. However, current literature remains fragmented and modestly sized regarding the equivalence of intracoronary versus intravenous adenosine. We aim to investigate the relationship between intracoronary adenosine and intravenous adenosine to determine FFR. METHODS We performed a lesion-level meta-analysis to compare intracoronary adenosine with intravenous adenosine (140 µg/kg per minute) for FFR assessment. The search was conducted in accordance to the Preferred Reporting for Systematic Reviews and Meta-Analysis statement. Lesion-level data were obtained by contacting the respective authors or by digitization of scatterplots using custom-made software. Intracoronary adenosine dose was defined as; low: <40 µg, intermediate: 40 to 99 µg, and high: ≥100 µg. RESULTS We collected 1972 FFR measurements (1413 lesions) comparing intracoronary with intravenous adenosine from 16 studies. There was a strong correlation (correlation coefficient =0.915; P<0.001) between intracoronary-FFR and intravenous-FFR. Mean FFR was 0.81±0.11 for intracoronary adenosine and 0.81±0.11 for intravenous adenosine (P<0.001). We documented a nonclinically relevant mean difference of 0.006 (limits of agreement: -0.066 to 0.078) between the methods. When stratified by the intracoronary adenosine dose, mean differences between intracoronary and intravenous-FFR amounted to 0.004, 0.011, or 0.000 FFR units for low-dose, intermediate-dose, and high-dose intracoronary adenosine, respectively. CONCLUSIONS The present study documents clinically irrelevant differences in FFR values obtained with intracoronary versus intravenous adenosine. Intracoronary adenosine hence confers a practical and patient-friendly alternative for intravenous adenosine for FFR assessment.

中文翻译：

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个别病灶水平的荟萃分析比较冠状动脉腔内注射腺苷的各种剂量与静脉内注射腺苷的分数流量储备评估。

背景技术腺苷的静脉内输注被认为是分数流量储备（FFR）评估的标准实践，但是与不良副作用相关并且耗时。患者对腺苷的冠脉内大剂量注射更好，更便宜且耗时更少。然而，关于冠状动脉内与静脉内腺苷的等效性，目前的文献仍然是零散的，规模不大。我们旨在调查冠状动脉内腺苷和静脉内腺苷之间的关系，以确定FFR。方法我们进行了病灶水平的荟萃分析，比较了冠状动脉内腺苷和静脉内腺苷（每分钟140 µg / kg）进行FFR评估。搜索是根据“系统评价和荟萃分析的首选报告”进行的。可以通过联系各自的作者或使用定制软件对散点图进行数字化来获得病变水平的数据。冠状动脉内腺苷剂量定义为：低：<40 µg，中：40至99 µg，高：≥100µg。结果我们从16项研究中收集了1972年FFR测量值（1413个病灶），比较了冠状动脉内注射和静脉内腺苷。冠状动脉内FFR和静脉内FFR之间有很强的相关性（相关系数= 0.915； P <0.001）。冠状动脉内腺苷的平均FFR为0.81±0.11，静脉内腺苷的平均FFR为0.81±0.11（P <0.001）。我们记录了两种方法之间的非临床相关平均差0.006（一致限：-0.066至0.078）。当按冠状动脉内腺苷剂量分层时，冠状动脉内和静脉内FRR之间的平均差异为0.004、0.011，小剂量，中剂量和大剂量冠状动脉内腺苷分别为0.000 FFR单位。结论本研究记录了冠状动脉内和静脉内腺苷获得的FFR值在临床上无相关性。因此，冠状动脉内腺苷为静脉内腺苷提供了一种实用且对患者友好的替代品，用于FFR评估。