Intracoronary versus intravenous adenosine to assess fractional flow reserve: A systematic review and meta-analysis

S. Gili, U. Barbero, D. Errigo, G. De Luca, G. Biondi-Zoccai, A.M. Leone, M. Iannaccone, A. Montefusco, P. Omedé, C. Moretti, M. D'Amico, F. Gaita, F. D'Ascenzo

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Aims Intravenous infusion of adenosine is the reference method to measure fractional flow reserve (FFR). Intracoronary boluses are often used because of time and convenience, but their effectiveness has yet to be assessed. Methods We conducted a systematic review and metaanalysis of prospective studies directly comparing intravenous and intracoronary adenosine administration for FFR measurement. FFR values and prevalence of functionally critical lesions obtained with the different methods of adenosine administration were compared. Results Twelve studies evaluating 781 lesions from 731 patients were included (63.7 years, 25.5% women, median FFR 0.82). FFR values were significantly lower with intravenous adenosine than with intracoronary adenosine [mean difference 0.01, 95% confidence interval (CI) 0.00- 0.02, P=0.005], even if no significant differences were observed when only high doses of intracoronary adenosine (≥ 150μg) were considered. The prevalence of functionally critical lesions did not significantly differ between intracoronary and intravenous adenosine. Concerning the use of different doses of intracoronary adenosine, low doses (≤ 60μg) were associated with higher FFR values (mean difference 0.02, 95% CI 0.01-0.03, P
Original languageEnglish
Pages (from-to)274-283
Number of pages10
JournalJournal of Cardiovascular Medicine
Issue number6
Publication statusPublished - 2018


  • adenosine
  • vasodilator agent, angina pectoris
  • atrioventricular block
  • bolus injection
  • coronary artery disease
  • diagnostic accuracy
  • dose response
  • drug dose comparison
  • drug megadose
  • drug safety
  • fractional flow reserve
  • human
  • intracoronary drug administration
  • low drug dose
  • meta analysis
  • Review
  • systematic review
  • systemic disease
  • thorax pain
  • coronary blood vessel
  • drug effect
  • hemodynamics
  • intravenous drug administration, Adenosine
  • Administration, Intravenous
  • Coronary Vessels
  • Fractional Flow Reserve, Myocardial
  • Hemodynamics
  • Humans
  • Vasodilator Agents


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