Dan, Kazuhiro

Ichihashi, Kei

Ishihara, Hiroki

Maeda, Takuya

Takahashi, Yuya

Tanaka, Nobukiyo

Teramoto, Tomohiko

Teramura, Masanori

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TCT-289 Nicorandil as Hyperemic Agent to Evaluate Fractional Flow Reserve 

B114 J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 6 , N O . 1 5 , S U P P L B , 2 0 1 5RESULTS Baseline characteristics of patients are shown in Table 1.
IMR was measured in 34 patients (one patient was excluded for a
technical problem). 56% of the patients were males with a mean age
of 70þ/-15 years. All procedures were performed by radial approach.
Pressure wire physiological measurements demonstrated a
signiﬁcant MD. IMR showed a median value of 32þ/-16 with normal
IMR in healthy humans being< 20-30U (median value of 12.6).
Coronary ﬂow reserve (CFR) was also concordant with a MD and
statistically associated with IMR (r¼ -04 p 0.03). A signiﬁcant
association between IMR and BNP levels were found (r¼ -0.4,
p 0.02). A nonsigniﬁcant correlation with age and IMR was found
(r¼ 0.32, p 0.06). Interestingly a signiﬁcantly lower IMR was found
in patients in treatment with beta-blockers (p 0,013). No signiﬁcant
relationship between IMR other clinical, biochemical, physiological
or echocardiogram parameters were found.
Table 1Characteristics Percentage/ValueDiabetes 26%Hypertension 57%Atrial ﬁbrillation 11,7%Severe aortic calciﬁcation 16%Beta blocker treatment 40%Oligosymptomatic 8,5%FFR<0.75 in LAD 3%Body mass index 28,9 þ/- 4.5 kg/m2
LV ejection fraction 62 þ/- 8.4 %
Mean gradient 53 þ/- 16 mm/Hg
Index AVA 0,44þ/- 11 cm2/m2
Ejection Time 0,299 þ/- 59 sec.
FFR 0,87 þ/- 0.8
CFR 1,39 þ/- 0.6CONCLUSIONS Invasive IMR measurement conﬁrm that patients with
AS have a high coronary resistance and MD. IMR showed a median
value of 32þ/-16 and was statistically associated with CFR and with
BNP levels. Interestingly a signiﬁcantly lower IMR was found in pa-
tients in treatment with beta-blockers.
CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
KEYWORDS Aortic stenosis, Coronary microcirculatory dysfunction,
Coronary Physiology
TCT-289
Nicorandil as Hyperemic Agent to Evaluate Fractional Flow Reserve
Nobukiyo Tanaka,1 Hiroki Ishihara,1 Takuya Maeda,1
Masanori Teramura,1 Yuya Takahashi,1 Kei Ichihashi,1 Kazuhiro Dan,1
Tomohiko Teramoto1
1Ichinomiya Nishi Hospital, Ichinomiya, Japan
BACKGROUND Fractional ﬂow reserve (FFR) is useful for determining
the functional signiﬁcance of epicardial coronary stenosis and may
facilitate clinical decision making in patients with an equivocal cor-
onary stenosis. Therefore, determining an efﬁcient and safe method
to achieve hyperemia is important for evaluating FFR.
METHODS We evaluated appropriate hyperemic dose of nicorandil
(NIC) in 42 vessels (LAD:27 vessels, CX:8 vessels, RCA: 7 vessels) of 30
patients. Next, we compared the FFR induced by ATP and by 2-mg NIC
in 170 vessels of 129 Japanese patients. Finally, we examined effect of
adding NIC to ATP to evaluate FFR in 41 vessels (LAD:31 vessels, CX:4
vessels, RCA: 6 vessels) of another 35 patients.
RESULTS 76.2% of vessels achieved hyperemia with 2-mg NIC. If an
accidental error was deﬁned as a difference of 0.01 in the FFR mea-
surements, hyperemia was achieved in 95.2% vessels when up to 2-mg
NIC was administered. The FFR values obtained with ATP were
signiﬁcantly correlated with those obtained with 2-mg NIC (regression
coefﬁcient ¼ 0.960, R2 ¼ 0.918, P < 0.001). FFR value were not
different in size of catheter (4Fr vs 5,6Fr), site of approach (TR vs
TB,TF), and type of catheter (sones vs others). There were one hy-
potension case needing a vasopressor and two cases of transient
second-degree atrioventricular block after ATP administration but
not after NIC administration (0.6% vs 0.0%, 1.2% vs 0.0%, not
signiﬁcantly). The time taken to achieve hyperemia after NIC
administration (17.78.7 s) was signiﬁcantly shorter than that afterATP administration (196.526.0 s) (P < 0.001). Adding 2-mg NIC to
ATP reduced FFR value, -0.0170.035, but not reaching signiﬁcance.
Reductions of FFR value were not different in size of catheter (4Fr vs
5,6Fr), site of approach (TR vs TB,TF), and type of catheter (sones vs
others), but FFR value in non LAD came down more than LAD (non-
LAD : -0.0380.034, LAD：-0.0100.033, p¼0.036).
CONCLUSIONS Intracoronary nicorandil administration is more use-
ful than and as safe as intravenous administration of ATP for evalu-
ating FFR in Japanese patients.
CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
KEYWORDS Fractional ﬂow reserve, Hyperemia, Nicorandil
TCT-290
Fractional Flow Reserve Measurement in Non-ST-Elevation Myocardial
Infarction: Analysis of the National Inpatient Sample Database
Nivas Balasubramaniyam,1 Prakash Harikrishnan,1 Tanush Gupta,1
wilbert S aronow,1 Chandrasekar Palaniswamy,1 Robert Timmermans,1
Hasan Ahmad,1 Howard A. Cooper,1 Julio A. Panza1
1New York Medical College @ Westchester Medical Center, Valhalla, NY
BACKGROUND Fractional ﬂow reserve (FFR) measurement is being
used increasingly in patients with coronary artery disease to guide
treatment. However, limited data are available on the contemporary
utilization rates and in-hospital outcomes of FFR measurement in
patients with non-ST-elevation myocardial infarction (NSTEMI).
METHODS We queried the 2009-2012 National Inpatient Sample (NIS)
databases to identify all patients admitted with the primary diagnosis
of NSTEMI (ICD-9-CM code 410.71). Multivariate logistic regression
and linear regression models were used to analyze the utilization rates
and in-hospital outcomes of FFR measurement in NSTEMI patients
undergoing coronary angiography.
RESULTS Of 1,605,295 (57.7% men, mean age 6914 years) patients
hospitalized with NSTEMI from 2009-2012, 992,183 (61.8%) under-
went coronary angiography. Among NSTEMI patients who underwent
coronary angiography, FFR measurement was performed in 9,086
(0.9%) patients. FFR utilization rates increased from 0.4% in 2009 to
1.5% in 2012 (adjusted OR per year, 1.46; 95% CI, 1.43-1.49; p<0.001).
Among NSTEMI patients who underwent coronary angiography, those
who had FFR measurement performed were less likely to undergo
percutaneous coronary intervention (PCI) (54.2% vs 54.4%; adjusted
OR, 0.91; 95% CI, 0.87-0.95, p<0.001) or coronary artery bypass
grafting (CABG) (9.9% vs 11.5%; adjusted OR, 0.79; 95% CI, 0.73-0.85,
p<0.001) compared to those who did not have FFR measured. In-
hospital mortality was lower (0.8% vs. 1.8%; adjusted OR, 0.53; 95%
CI, 0.42-0.67, p<0.001) and average length of stay was shorter (4.4
days vs 4.8 days; adjusted parameter estimate 0.96; 95% CI 0.95-0.98;
p<0.001) in FFR group compared to the no FFR group. Average total
hospital charges were higher in the FFR group compared to the no FFR
group ($82,621 vs $79,019; adjusted parameter estimate 1.05; 95% CI
1.04-1.07; p<0.001).
CONCLUSIONS In NSTEMI patients undergoing coronary angiog-
raphy, although we observed an increasing trend in the use of FFR
measurement over the last few years, the absolute utilization rates
remain exceedingly low. FFR measurement during coronary angiog-
raphy is associated with lower revascularization rates, lower in-hos-
pital mortality, shorter average length of stay, but higher average
hospital charges.
CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
KEYWORDS Fractional ﬂow reserve, Non-ST elevation myocardial
infarction
TCT-291
Comparison of Simpliﬁed and Comprehensive Methods for
Assessing the Index of Microvascular Resistance in Heart
Transplant Recipients
Ole Geir Solberg,1 Lars Aaberge,1 Marit Aas,1 Knut Endresen,1
Lars Gullestad,1 Asgrimur Ragnarsson,1 Jurat _e Saltyt _e Benth,2
Knut Stavem2
1Oslo University Hospital Rikshospitalet, Oslo, Norway; 2Institute of
Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog,
Norway
BACKGROUND Coronary physiologic methods like coronary ﬂow
reserve, fractional ﬂow reserve and the index of microvascular resis-
tance (IMR) have emerged as complementary methods to angiography
and intravascular ultrasound for assessing the physiological status of


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TCT-289 Nicorandil as Hyperemic Agent to Evaluate Fractional Flow Reserve

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