Exogenous adenosine triphosphate disodium administration during primary percutaneous coronary intervention reduces no-reflow and preserves left ventricular function in patients with acute anterior myocardial infarction: a study using myocardial contrast echocardiography.
BACKGROUND
It is unknown whether adenosine triphosphate disodium (ATP) administration during primary percutaneous coronary intervention (PCI) is useful in anterior acute myocardial infarction (AMI).


METHODS
The study was a prospective, non-randomized, open-label trial. Primary PCI was successfully performed in 204 consecutive patients with first anterior AMI. ATP at a mean dose of 117 microg/kg/min for 45 min on an average was infused intravenously during PCI in 100 patients (Group 1). In the other 104 patients, normal saline was administered (Group 2). ST-segment resolution (STR) was estimated 90 min after recanalization. The no-reflow ratio was measured 2 weeks later, using intravenous myocardial contrast echocardiography. Left ventricular ejection fraction (LVEF), LV regional wall motion (LVRWM), and LV end-diastolic volume index (LVEDVI) were measured 6 months later.


RESULTS
Baseline patient characteristics of the two groups were similar, including TIMI risk scores. Significant STR (> or =50% resolution compared to baseline) (66% versus 50%; Group 1 versus Group 2, p=0.02), no-reflow ratio (24% versus 34%, indicated by mean values, p=0.02), LVEF (61% versus 55%, p=0.0007), LVRWM (-1.56 versus -2.05, using the SD/chord, p=0.0001), and LVEDVI (60 ml/m(2) versus 71 ml/m(2), p=0.0007) were significantly better in Group 1, and the no-reflow ratio, LVEF, LVRWM and LVEDVI were significantly better in ATP-administered patients, regardless of antecedent angina or advanced age. ATP Administration was consistently identified as a significant determinant for STR, no-reflow ratio, LVEF, LVRWM, and LVEDVI.


CONCLUSIONS
Intravenous ATP administration during reperfusion is an independent determinant of STR and the no-reflow ratio, and LVEF, LVRWM, and LVEDVI at 6 months after primary PCI.
Sakuma
Tadamichi
T
Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan. tasakum@hotmail.com
Motoda
Chikaaki
C
Tokuyama
Takehito
T
Oka
Toshiharu
T
Tamekiyo
Hiromichi
H
Okada
Takenori
T
Otsuka
Masaya
M
Okimoto
Tomokazu
T
Toyofuku
Mamoru
M
Hirao
Hidekazu
H
Muraoka
Yuji
Y
Ueda
Hironori
H
Masaoka
Yoshiko
Y
Hayashi
Yasuhiko
Y
D000255:Adenosine Triphosphate / Q000008:administration & dosage*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000592:standards; D056988:Anterior Wall Myocardial Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D003131:Combined Modality Therapy; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*
D000255:Adenosine Triphosphate