Masao Miyagawa MD,PhD, Presenter: Nothing to Disclose

Hiroshi Higashino MD, Abstract Co-Author: Nothing to Disclose

Michinobu Nagao MD, Abstract Co-Author: Nothing to Disclose

Teruhito Kido MD, Abstract Co-Author: Nothing to Disclose

Yasushi Koyama MD, Abstract Co-Author: Nothing to Disclose

Teruhito Mochizuki MD, Abstract Co-Author: Nothing to Disclose

Adenosine 5'-triphosphate (ATP) is reported to be slightly more potent than adenosine (AD) for the measurement of flow reserve in stenotic and nonstenotic coronary arteries. The purpose of this study was to determine the safety of ATP infusion protocol with myocardial perfusion imaging (MPI) in 6499 consecutive patients (pts).

At 8 clinical institutions, we prospectively studied pts with known or suspected coronary artery disease referred for clinically indicated MPI who were unable to perform exercise. ATP was infused at 0.16 mg/kg per min for 5 min. After 3 min of infusion, the isotope was intravenously injected. Each pt was carefully monitored and questioned during and after ATP infusion for the occurrence of adverse events. All adverse events were recorded on standardized forms. Results were compared with those of the AD Multicenter Trial Registry.

The ATP infusion protocol was completed in 6422 pts (98.8%) and terminated early in 77 pts (1.2%). Despite the early termination, all pts received the injection of isotope. None of the pts required dose reduction or treatment with aminophylline. There were no deaths or myocardial infarctions. Pts who received ATP had fewer adverse events (58.4%) than did those who received AD (81.1%, p<0.0001). Chest pain (18.3%), flushing (8.8%), headache (8.1%), neck discomfort (7.7%) and dyspnea (6.0%) occurred less often with ATP in comparison with AD (p<0.0001). Moreover, AV block of any type occurred in only 2.2% of pts with ATP, while it did in 7.6% with AD (p<0.0001). The following baseline to maximal changes were recorded during the protocol: heart rate increased from 64.3±11.2 to 81.8±13.4 beats/min and systolic blood pressure decreased from 142.4±24.7 to 117.9±19.2 mmHg (p<0.0001). Slightly greater increase in heart rate and decrease in systolic blood pressure with ATP suggests that it has a marginally greater coronary vasodilatory effect than AD.

ATP is almost equivalent to AD in achieving coronary hyperemia with the advantage of lower rate of side effects, longer duration and potentially lower cost. ATP may be preferable to AD or dipyridamole as the routine pharmacologic stress agent.

Adenosine 5'-triphosphate (ATP) is reported to be slightly more potent than adenosine (AD) for the measurement of flow reserve in stenotic and nonstenotic coronary arteries. The purpose of this study was to determine the safety of ATP infusion protocol with myocardial perfusion imaging (MPI) in 6499 consecutive patients (pts).

At 8 clinical institutions, we prospectively studied pts with known or suspected coronary artery disease referred for clinically indicated MPI who were unable to perform exercise. ATP was infused at 0.16 mg/kg per min for 5 min. After 3 min of infusion, the isotope was intravenously injected. Each pt was carefully monitored and questioned during and after ATP infusion for the occurrence of adverse events. All adverse events were recorded on standardized forms. Results were compared with those of the AD Multicenter Trial Registry.

The ATP infusion protocol was completed in 6422 pts (98.8%) and terminated early in 77 pts (1.2%). Despite the early termination, all pts received the injection of isotope. None of the pts required dose reduction or treatment with aminophylline. There were no deaths or myocardial infarctions. Pts who received ATP had fewer adverse events (58.4%) than did those who received AD (81.1%, p<0.0001). Chest pain (18.3%), flushing (8.8%), headache (8.1%), neck discomfort (7.7%) and dyspnea (6.0%) occurred less often with ATP in comparison with AD (p<0.0001). Moreover, AV block of any type occurred in only 2.2% of pts with ATP, while it did in 7.6% with AD (p<0.0001). The following baseline to maximal changes were recorded during the protocol: heart rate increased from 64.3±11.2 to 81.8±13.4 beats/min and systolic blood pressure decreased from 142.4±24.7 to 117.9±19.2 mmHg (p<0.0001). Slightly greater increase in heart rate and decrease in systolic blood pressure with ATP suggests that it has a marginally greater coronary vasodilatory effect than AD.

ATP is almost equivalent to AD in achieving coronary hyperemia with the advantage of lower rate of side effects, longer duration and potentially lower cost. ATP may be preferable to AD or dipyridamole as the routine pharmacologic stress agent.

Miyagawa, M, Higashino, H, Nagao, M, Kido, T, Koyama, Y, Mochizuki, T, Safety of ATP Stress Myocardial Perfusion Imaging in 6499 Patients with Coronary Artery Disease: A Multicenter Study.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4409833.html