Efficacy and Safety of High-Dose Intracoronary Adenosine Injection in Fractional Flow Reserve Assessment

Chien Boon Jong*, Min Tsun Liao, Tsui Shan Lu, Shih Wei Meng, Chun Kai Chen, Ya Chin Tsai, Jui Cheng Kuo, Chih Cheng Wu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: The recommended dosage of intracoronary adenosine in fractional flow reserve (FFR) assessment is controversial. High-dose adenosine may overcome the biological variability of adenosine response in hyperemia. Objectives: We aimed to test the efficacy and safety of a high-dose escalation protocol at our institute. Methods: Using the adenosine dose escalation protocol, the percentages of FFR ≤ 0.75 and 0.80 after high-dose escalation were compared with those at conventional doses. The chi-squared test was used to evaluate the accuracy of FFR values with the tested doses by comparing them with the results of a non-invasive pretest. Results: A total of 87 patients (130 vessels) were included, and protocol adherence was 93.1%. High-dose intracoronary adenosine was injected in 78.5% of the vessels. The dose escalation strategy was well-tolerated without serious complications. The positive rate increased significantly after conducting the protocol compared to that with a conventional dose (28.2% vs. 23.6% with an FFR threshold of 0.75, and 48.7% vs. 42.5% with a threshold of 0.80, both p < 0.05). In the validation cohort, only FFR ≤ 0.75 was associated with the binary result of the non-invasive pretest (p < 0.01 vs. p = 0.37). The high-dose adenosine escalation strategy did not increase the accuracy of FFR (77.8% vs. 75.6% in conventional dose and high-dose adenosine, respectively). Conclusions: The use of a high-dose escalation strategy increased the positive rate in FFR assessments.

Original languageEnglish
Pages (from-to)553-563
Number of pages11
JournalActa Cardiologica Sinica
Issue number5
Publication statusPublished - 2022


  • Adenosine
  • Ischemia
  • Myocardial fractional flow reserve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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