{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:09:12Z","timestamp":1790683752889,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fractional flow reserve (FFR)\u2010guided revascularization improves long\u2010term 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\u2010like and ATP\u2010sensitive potassium channel\u2013activating properties. However, data on long\u2010term vessel\u2010related outcomes guided by NIC\u2010induced FFR are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To compare long\u2010term clinical and vessel\u2010based outcomes in patients with suspected angina pectoris whose treatment strategies were guided by ATP\u2010induced FFR (ATP\u2010FFR) versus intracoronary nicorandil\u2010induced FFR (NIC\u2010FFR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center, 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\u2009\u00b5g\/kg\/min) and\/or intracoronary NIC (2\u2009mg bolus). Ischemic and non\u2010ischemic groups were defined as FFR\u2009\u2264\u20090.80 and &gt;\u20090.80, respectively. Long\u2010term clinical events were evaluated over a mean follow\u2010up of 6.4\u2009\u00b1\u20093.1 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u2009\u2264\u20090.80), the incidence of acute coronary syndrome (ACS) was 0.0% for ATP\u2010FFR and 0.4% for NIC\u2010FFR (log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.328), and chronic coronary syndrome (CCS) occurred in 15.9% and 16.4%, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.059). Among non\u2010ischemic vessels (FFR\u2009&gt;\u20090.80), ACS occurred in 0.7% versus 0.3% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.521) and CCS in 7.6% versus 5.8% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.374). Kaplan\u2013Meier analyses showed no significant differences between the two hyperemic agents across all subgroups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intracoronary NIC can be safely and effectively used as an alternative hyperemic agent for FFR measurement. Long\u2010term vessel\u2010related outcomes guided by NIC\u2010FFR showed no statistically significant differences compared with those guided by ATP\u2010FFR, supporting its applicability in real\u2010world practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70907","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:49:26Z","timestamp":1790682566000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Outcomes of Patients With Suspected Angina Pectoris Following Clinical Decision\u2010Making Guided by ATP\u2010FFR Versus Nicorandil\u2010FFR"],"prefix":"10.1002","author":[{"given":"Nobukiyo","family":"Tanaka","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Ichinomiya Nishi Hospital Ichinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Ichinomiya Nishi Hospital Ichinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Ichinomiya Nishi Hospital Ichinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshio","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Ichinomiya Nishi Hospital Ichinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1056\/NEJM199606273342604","article-title":"Measurement of Fractional Flow Reserve to Assess the Functional Severity of Coronary\u2010Artery Stenoses","volume":"334","author":"Pijls N. H. J.","year":"1996","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1161\/01.CIR.104.2.157","article-title":"Fractional Flow Reserve in Patients With Prior Myocardial Infarction","volume":"104","author":"De Bruyne B.","year":"2001","journal-title":"Circulation"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"3183","DOI":"10.1161\/01.CIR.92.11.3183","article-title":"Fractional Flow Reserve: A Useful Index to Evaluate the Influence of an Epicardial Coronary Stenosis on Myocardial Blood Flow","volume":"92","author":"Pijls N. H. J.","year":"1995","journal-title":"Circulation"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1056\/NEJMoa1205361","article-title":"Fractional Flow Reserve\u2013Guided PCI Versus Medical Therapy in Stable Coronary Disease","volume":"367","author":"De Bruyne B.","year":"2012","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1056\/NEJMoa0807611","article-title":"Fractional Flow Reserve Versus Angiography for Guiding Percutaneous Coronary Intervention","volume":"360","author":"Tonino P. A. L.","year":"2009","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.jacc.2010.04.012","article-title":"Fractional Flow Reserve Versus Angiography for Guiding Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease","volume":"56","author":"Pijls N. H. J.","year":"2010","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/j.jacc.2007.01.087","article-title":"Percutaneous Coronary Intervention of Functionally Nonsignificant Stenosis","volume":"49","author":"Pijls N. H. J.","year":"2007","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_11_9_1","first-page":"401","article-title":"Comparison of Hyperemic Efficacy Between Central and Peripheral Venous Adenosine Infusion for Fractional Flow Reserve Measurement","volume":"5","author":"Seo M. K.","year":"2012","journal-title":"Circulation: Cardiovascular Interventions"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1097\/00005344-200006000-00014","article-title":"Effects of Intravenous Nicorandil on Coronary Circulation in Humans: Plasma Concentration and Action Mechanism","volume":"35","author":"Nakae I.","year":"2000","journal-title":"Journal of Cardiovascular Pharmacology"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1016\/S0140-6736(02)08265-X","article-title":"Effect of Nicorandil on Coronary Events in Patients With Stable Angina: The Impact Of Nicorandil in Angina (IONA) Randomised Trial","volume":"359","author":"The IONA Study Group","year":"2002","journal-title":"Lancet"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1253\/circj.70.1099","article-title":"Impact of Nicorandil to Prevent Reperfusion Injury in Patients With Acute Myocardial Infarction Sigmart Multicenter Angioplasty Revascularization Trial (SMART): Sigmart Multicenter Angioplasty Revascularization Trial (SMART)","volume":"70","author":"Ota S.","year":"2006","journal-title":"Circulation Journal"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1253\/circj.CJ-08-0212","article-title":"Effect of Intracoronary Nicorandil Administration Prior to Reperfusion in Acute ST\u2010Segment Elevation Myocardial Infarction","volume":"72","author":"Lee H. C.","year":"2008","journal-title":"Circulation Journal"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1002\/clc.22344","article-title":"Usefulness and Safety of Intracoronary Administration of Nicorandil for Evaluating Fractional Flow Reserve in Japanese Patients","volume":"38","author":"Tanaka N.","year":"2015","journal-title":"Clinical Cardiology"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1093\/eurheartj\/eht040","article-title":"Safety and Efficacy of a Novel Hyperaemic Agent, Intracoronary Nicorandil, for Invasive Physiological Assessments in the Cardiac Catheterization Laboratory","volume":"34","author":"Jang H. J.","year":"2013","journal-title":"European Heart Journal"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s00380-014-0508-5","article-title":"Feasibility and Safety of Intracoronary Nicorandil Infusion as a Novel Hyperemic Agent for Fractional Flow Reserve Measurements","volume":"30","author":"Kato D.","year":"2015","journal-title":"Heart and Vessels"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"e208","DOI":"10.4244\/EIJV12I2A34","article-title":"Safety and Efficacy of Intracoronary Nicorandil as Hyperaemic Agent for Invasive Physiological Assessment: A Patient\u2010Level Pooled Analysis","volume":"12","author":"Lee J. M.","year":"2016","journal-title":"EuroIntervention"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1056\/NEJM198403293101304","article-title":"Does Visual Interpretation of the Coronary Arteriogram Predict the Physiologic Importance of a Coronary Stenosis?","volume":"310","author":"White C. W.","year":"1984","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_19_1","first-page":"1051","article-title":"Visual\u2013Functional Mismatch Between Coronary Angiography and Fractional Flow Reserve","volume":"93","author":"Berry C.","year":"2004","journal-title":"American Journal of Cardiology"},{"key":"e_1_2_11_20_1","article-title":"Diagnostic Performance of Angiography\u2010Based Quantitative Flow Ratio Compared With Fractional Flow Reserve","volume":"9","author":"Hwang D.","year":"2020","journal-title":"Journal of the American Heart Association"},{"key":"e_1_2_11_21_1","first-page":"283","article-title":"Fractional Flow Reserve and the Prognosis of Patients With Coronary Artery Disease","volume":"55","author":"Fearon W. F.","year":"2010","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_11_22_1","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1161\/01.CIR.80.2.324","article-title":"The Excitable Gap in Atrioventricular Nodal Reentrant Tachycardia. Characterization With Ventricular Extrastimuli and Pharmacologic Intervention","volume":"80","author":"Schuger C. D.","year":"1989","journal-title":"Circulation"},{"key":"e_1_2_11_23_1","first-page":"440","article-title":"Role of Adenosine in the Hyperemic Response to Intracoronary Papaverine","volume":"41","author":"Meuwissen M.","year":"2003","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_11_24_1","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1056\/NEJM199406233302503","article-title":"Relation Between Myocardial Blood Flow and the Severity of Coronary\u2010Artery Stenosis","volume":"330","author":"Uren N. G.","year":"1994","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_25_1","first-page":"109","article-title":"Clinical Impact of Intracoronary Nicorandil Versus Adenosine Triphosphate for Fractional Flow Reserve\u2013Guided Revascularization","volume":"240","author":"Kurita A.","year":"2017","journal-title":"International Journal of Cardiology"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70907","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70907","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70907","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:49:29Z","timestamp":1790682569000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70907"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":24,"alternative-id":["10.1002\/ccd.70907"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70907","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"assertion":[{"value":"2026-01-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ccd.70907"}}