Long-Term Outcomes of Patients With Suspected Angina Pectoris Following Clinical Decision-Making Guided by ATP-FFR Versus Nicorandil-FFR.

BACKGROUND

Fractional flow reserve (FFR)-guided revascularization improves long-term outcomes in patients with coronary artery disease. Although adenosine triphosphate (ATP) is the standard hyperemic agent, nicorandil (NIC) has emerged as a practical alternative due to its combined nitrate-like and ATP-sensitive potassium channel-activating properties. However, data on long-term vessel-related outcomes guided by NIC-induced FFR are limited.

AIMS: To compare long-term clinical and vessel-based outcomes in patients with suspected angina pectoris whose treatment strategies were guided by ATP-induced FFR (ATP-FFR) versus intracoronary nicorandil-induced FFR (NIC-FFR).

METHODS

This single-center, prospective registry enrolled 363 consecutive patients (543 vessels) who underwent FFR measurement between April 2012 and December 2017. FFR was assessed using intravenous ATP infusion (150 µg/kg/min) and/or intracoronary NIC (2 mg bolus). Ischemic and non-ischemic groups were defined as FFR ≤ 0.80 and > 0.80, respectively. Long-term clinical events were evaluated over a mean follow-up of 6.4 ± 3.1 years.

RESULTS

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were performed in 123 (33.9%) and 5 (1.4%) patients, respectively. Overall, target vessel revascularization occurred in 3.0% of vessels. In the ischemic groups (FFR ≤ 0.80), the incidence of acute coronary syndrome (ACS) was 0.0% for ATP-FFR and 0.4% for NIC-FFR (log-rank p = 0.328), and chronic coronary syndrome (CCS) occurred in 15.9% and 16.4%, respectively (p = 0.059). Among non-ischemic vessels (FFR > 0.80), ACS occurred in 0.7% versus 0.3% (p = 0.521) and CCS in 7.6% versus 5.8% (p = 0.374). Kaplan-Meier analyses showed no significant differences between the two hyperemic agents across all subgroups.

CONCLUSIONS

Intracoronary NIC can be safely and effectively used as an alternative hyperemic agent for FFR measurement. Long-term vessel-related outcomes guided by NIC-FFR showed no statistically significant differences compared with those guided by ATP-FFR, supporting its applicability in real-world practice.