Gill GS, Gadre A, Kanmanthareddy A. Comparative efficacy and safety of adenosine and regadenoson for assessment of fractional flow reserve: A systematic review and meta-analysis. World J Cardiol 2022; 14(5): 319-328 [PMID: 35702325 DOI: 10.4330/wjc.v14.i5.319]
Corresponding Author of This Article
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
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
Regadenoson is a selective adenosine receptor agonist that causes coronary hyperemia and in limited studies has been shown to have comparative efficacy to adenosine in evaluating coronary fractional flow reserve (FFR).
Research motivation
Considering the evidence is limited in supporting the use of regadenoson as an alternative to adenosine in evaluating FFR, we hypothesized that using meta-analysis we can improve the strength of evidence comparing regadenoson vs adenosine in evaluating FFR in intermediate severity coronary stenosis.
Research objectives
To perform meta-analysis to evaluate regadenoson vs adenosine for efficacy and safety.
Research methods
Pooled meta-analysis of published studies. Comparing correlation coefficient and adverse events using random effects model. Visual inspection for bias and heterogeneity assessment using I2 test.
Research results
The FFR correlation coefficient between regadenoson and adenosine was 0.98 [95% confidence interval (CI): 0.96-0.99, P < 0.01]. Time to achieve FFR was shorter by 34.31 s (95%CI: 25.14-43.48) in the regadenoson group. The risk of adverse events was higher with adenosine with odds ratio of 2.39 (95%CI: 1.22-4.67, P = 0.01).
Research conclusions
Regadenoson had comparable efficacy in obtaining FFR compared to adenosine and this was achieved in a shorter duration of time and with lower incidence of adverse effects.
Research perspectives
Regadenoson presents an alternative to adenosine in evaluating FFR in patients with intermediate severity coronary artery stenosis with lower risk of side effects and also saves time.
