Comparative efficacy and safety of adenosine and regadenoson for assessment of fractional flow reserve: A systematic review and meta-analysis

Table 1 Study characteristics of included investigations

Ref.	Country	Patients (n)	Population	Enrollment period	Adenosine dosing	Regadenoson dosing	Inclusion/exclusion criteria	Measured outcomes
Nair et al[10], 2011	United States	25	Prospective, single-center	July 2009-December 2010	IV adenosine infusion at 140 μg/kg/min	IV regadenoson bolus 400 μg	Inclusion: Elective angiography, intermediate stenosis (40%-70%), remainder per ADVANCE trial (2)	FFR correlation, flushing, dyspnea, headache, chest discomfort, nausea, diaphoresis, metallic taste
Arumugham et al[11], 2013	United States	20	Prospective, single-center	October 2009-September 2010	IV adenosine infusion at 175 μg/kg/min	IV regadenoson bolus 400 μg	Inclusion: Intermediate stenosis (50%-80%). Exclusion: STEMI within 5 d, significant left main coronary artery stenosis, heart block, pregnancy, asthma or hypersensitive to either adenosine or regadenoson	FFR correlation, time to achieve FFR, effect on blood pressure and heart rate, heart block, bronchospasm, severe chest pain
Prasad et al[12], 2014	United States	571	Prospective, multi-center	May 2011-November 2011	IV adenosine at 140 μg/kg/min	IV regadenoson bolus 400 μg	Inclusion: Intermediate stenosis (50%-70%). Exclusion: Age < 18 years old, 3-vessel CAD, ACS within 1 wk, prior MI in territory supplied by target lesion, hypersensitivity to adenosine or regadenoson, reactive airway disease, 2nd or 3rd heart block, currently receiving dipyridamole, hemodynamic instability	FFR correlation, blood pressure, change in heart rate, dizziness, shortness of breath, heart block, flushing, arrhythmias
Van Nunen et al[13], 2015	Netherlands	100	Prospective, single-center	NA	IV adenosine at 140 μg/kg/min	IV regadenoson bolus 400 μg	Inclusion: Ages 18-80 years old, lesions in proximal to mid coronary artery segments, at least 2 mm diameter, > 30% stenosis. Exclusion: Severe AS, 2nd-3rd heart block, acute MI within 5 d, bradycardia, severe hypotension, tortuous/calcified coronary vessels, severe asthma, pregnancy, inability to obtain femoral approach, dipyridamole within 48 h and methylxanthines within 12 h	FFR correlation, heart block, chest discomfort, blood pressure, heart rate, shortness of breath, nausea
Edward et al[14], 2018	United States	46	Prospective, single-center	April 2012-May 2014	IV adenosine at 140 μg/kg/min	IV regadenoson bolus 400 μg	Inclusion: Elective angiography, < 30%, >90% stenosis. Exclusion: Sinus node dysfunction, 2nd-3rd degree AV block without pacemaker, severe hypotension, acute MI within 30 d, severe AS, pregnancy, aberrant coronary anatomy or calcification	FFR correlation, time to reversal with aminophylline, side effects

¹60 lesions from 57 patients were included in the analysis.

IV: Intra-venous; STEMI: ST-segment elevation myocardial infarction; FFR: Fractional flow reserve; CAD: Coronary artery disease; ACS: Acute coronary syndrome; MI: Myocardial infarction; AV: Atrioventricular; AS: Aortic stenosis; NA: Not available; IC: Intra-coronary.

Table 2 Baseline characteristics of patients from studies included in the meta-analysis

	Nair et al[10]	Arumugham et al[11]	Prasad et al[12]	van Nunen et al[13]	Edward et al[14]
Number	25	20	57 (60 lesions)	100	46
Age [yrs ± SD or yrs (CIs)]	63 ± 11	63.9 ± 9	57 ± 8	66 ± 8	63 ± 10
Women, n (%)	12 (48)	4 (20)	10 (18)	25 (25)	9 (20)
Body mass index (mean ± SD)	30.0 ± 5.7	NA	27.7 ± 4.1	26.7; H kg	33 ± 7
Hypertension, n (%)	21 (84)	NA	51 (90)	54	44 (96)
Diabetes mellitus, n (%)	6 (24)	NA	26 (46)	21	26 (57)
Hyperlipidemia, n (%)	21 (84)	NA	39 (68)	36	44 (96)
Tobacco use, n (%)	8 (32)	NA	24 (42)	20	7 (15)
CKD, n (%)	NA	NA	NA	NA	9 (20)
Prior MI, n (%)	5 (20)	NA	23 (40)	36	NA
Prior PCI, n (%)	8 (32)	NA	NA	43	NA

CI: Confidence interval; CKD: Chronic kidney disease; MI: Myocardial infarction; PCI: Percutaneous intervention; NA: Not available.