title: 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.
abstract: 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.
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan. tasakum@hotmail.com
authors.forename: Tadamichi
authors.initials: T
authors.lastname: Sakuma
authors.forename: Chikaaki
authors.initials: C
authors.lastname: Motoda
authors.forename: Takehito
authors.initials: T
authors.lastname: Tokuyama
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Oka
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Tamekiyo
authors.forename: Takenori
authors.initials: T
authors.lastname: Okada
authors.forename: Masaya
authors.initials: M
authors.lastname: Otsuka
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Okimoto
authors.forename: Mamoru
authors.initials: M
authors.lastname: Toyofuku
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Hirao
authors.forename: Yuji
authors.initials: Y
authors.lastname: Muraoka
authors.forename: Hironori
authors.initials: H
authors.lastname: Ueda
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Masaoka
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
mesh_terms: 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*
chemical_list: D000255:Adenosine Triphosphate