Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2022; 14(5): 319-328
Published online May 26, 2022. doi: 10.4330/wjc.v14.i5.319
Comparative efficacy and safety of adenosine and regadenoson for assessment of fractional flow reserve: A systematic review and meta-analysis
Gauravpal Singh Gill, Akshaya Gadre, Arun Kanmanthareddy
Gauravpal Singh Gill, Arun Kanmanthareddy, Cardiovascular Medicine, Creighton University School of Medicine, Omaha, NE 68124, United States
Akshaya Gadre, Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49007, United States
Author contributions: Gill GS and Gadre A independently conducted literature search for studies to be included in the final analysis; all authors discussed disagreement in included studies; Gill GS prepared the first manuscript draft, tables and figures, conducted statistical analysis, and contributed to major revision; Gadre A contributed to revisions; Kanmanthareddy A conceptualized the study, performed independent statistical analysis, supervised methodology, made substantial changes to the manuscript, and contributed to major revision.
Conflict-of-interest statement: The authors do not have any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arun Kanmanthareddy, MD, MS, Assistant Professor, Cardiovascular Medicine, Creighton University School of Medicine, 7710 Mercy Road, Suite 401, Omaha, NE 68124, United States. akanmantha@gmail.com
Received: April 13, 2021
Peer-review started: April 13, 2021
First decision: October 17, 2021
Revised: November 21, 2021
Accepted: April 26, 2022
Article in press: April 26, 2022
Published online: May 26, 2022
Processing time: 400 Days and 6.8 Hours
Abstract
BACKGROUND

Adenosine is a coronary hyperemic agent used to measure invasive fractional flow reserve (FFR) of intermediate severity coronary stenosis.

AIM

To compare FFR assessment using adenosine with an alternate hyperemic agent, regadenoson.

METHODS

PubMed, Google Scholar, CINAHL and Cochrane databases were queried for studies comparing adenosine and regadenoson for assessment of FFR. Data on FFR, correlation coefficient and adverse events from the selected studies were extracted and analyzed by means of random effects model. Two tailed P-value less than 0.05 was considered significant. Heterogeneity was assessed using I2 test.

RESULTS

Five studies with 248 patients were included in the final analysis. All included patients and coronary lesions underwent FFR assessment using both adenosine and regadenoson. There was no significant mean difference between FFR measurement by the two agents [odds ratio (OR) = -0.00; 95% confidence interval (CI): (-0.02)-0.01, P = 0.88]. The cumulative correlation coefficient was 0.98 (0.96-0.99, P < 0.01). Three of five studies reported time to FFR with cumulative results favoring regadenoson (mean difference 34.31 s; 25.14-43.48 s, P < 0.01). Risk of adverse events was higher with adenosine compared to regadenoson (OR = 2.39; 95%CI: 1.22-4.67, P = 0.01), which most commonly included bradycardia and hypotension. Vast majority of the adverse events associated with both agents were transient.

CONCLUSION

The performance of regadenoson in inducing maximal hyperemia was comparable to that of adenosine. There was excellent correlation between the FFR measurements by both the agents. The use of adenosine, was however associated with higher risk of adverse events and longer time to FFR compared to regadenoson.

Keywords: Adenosine; Regadenoson; Fractional flow reserve; Meta-analysis

Core Tip: Regadenoson has comparable efficacy in inducing maximal coronary hyperemia in patients undergoing invasive coronary angiography with lower risk of side effects compared to adenosine. To compare fractional flow reserve (FFR) assessment using adenosine with an alternate hyperemic agent, regadenoson. PubMed, Google Scholar, CINAHL and Cochrane databases were queried for studies comparing adenosine and regadenoson for assessment of FFR. There was excellent correlation between the FFR measurements by both the agents. The use of adenosine, was however associated with higher risk of adverse events and longer time to FFR compared to regadenoson.