Pretreatment with intracoronary adenosine reduces the incidence of myonecrosis after non-urgent percutaneous coronary intervention: a prospective randomized study.
OBJECTIVE
We sought to investigate the effect of adenosine pretreatment on the incidence of myonecrosis after non-urgent percutaneous coronary intervention (PCI).


RESULTS
This was a prospective, randomized, open-label study. Patients who were scheduled for non-urgent PCI in de novo native coronary arteries were eligible. All patients were pretreated with aspirin and clopidogrel. Myonecrosis was measured by creatine kinase-myocardial band (CK-MB) elevation after PCI. A total of 62 patients were randomized into the adenosine (n = 31) or standard (n = 31) group. The adenosine group received 50 microg adenosine bolus before wiring of each lesion, whereas the standard group did not. Post-PCI myonecrosis occurred more frequently in the standard group (39 vs. 13%, OR 0.23, 95% CI 0.05-0.95, P = 0.020). After adjustment for drug-eluting stent implantation, multi-vessel stenting, and elevated baseline troponin, the OR was 0.19 (95% CI 0.05-0.72, P = 0.017). The median peak values of CK-MB in the adenosine and standard groups were 2 and 4 microg/L, respectively (P = 0.033). The adjusted difference was 1.95 microg/L (95% CI 0.13-3.77, P = 0.037). The incidences of myocardial infarction (>3 x CK-MB) were 6 and 16% in the adenosine and standard groups, respectively (OR 0.36; 95% CI 0.03-2.46, P = 0.229).


CONCLUSIONS
Pretreatment with 50 microg of adenosine decreases the incidence of myonecrosis after non-urgent PCI compared with that without pretreatment.
Lee
Chi-Hang
CH
Cardiac Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. leerch@hotmail.com
Low
Adrian
A
Tai
Bee-Choo
BC
Co
Melissa
M
Chan
Mark Y
MY
Lim
Jimmy
J
Lim
Yean-Teng
YT
Tan
Huay-Cheem
HC
D000241:Adenosine / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D015607:Stents; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D000241:Adenosine