Abstract 15437: Intravenous Nicorandil versus Adenosine for Fractional Flow Reserve Measurement to Assess Coronary Artery Stenosis: A Systematic Review and Meta-analysis

Abstract

Background: Fractional flow reserve (FFR) has become an increasingly accepted modality to assess coronary artery stenosis. Several clinical trials have been conducted to compare the effects of various pharmacologic agents, including nicorandil and adenosine, in achieving maximum coronary hyperemia. Methods: We searched PubMed, Cochrane Library, Scopus, and Web of Sciencefor randomized and observational studies comparing nicorandil with adenosine for measurement of FFR. Data were extracted from the eligible studies and pooled in a meta-analysis using the Revman software. Dichotomous data were pooled as risk ratio (RR) and continuous data were pooled as standardized mean difference (SMD) with the corresponding 95% confidence intervals (CI).We aimed to evaluate the average FFR, hyperemia, duration of hyperemia, decrease in systolic blood pressure, and pain scores assessed by visual analog scale (VAS). Results: Five studies comprising a total of 595 patients met our inclusion criteria. The combined effect estimate favored nicorandil over adenosine for mean FFR (SMD = -0.17, 95% CI [-0.28, -0.06], P = 0.004). Nicorandil was more effective in achieving adequate hyperemia as compared to adenosine (SMD = -2.06, 95% CI [-4.36, -0.84], P=0.004). However, no significant differences were reported between nicorandil and adenosine in the duration of hyperemia, the decrease in systolic blood pressure, and VAS pain scores. Conclusion: Nicorandil is associated with superior clinical outcomes and similar safety profile as compared to adenosine and should therefore be considered as an alternative agent for FFR evaluation.