Effect of high-dose intracoronary adenosine administration during primary percutaneous coronary intervention in acute myocardial infarction: a randomized controlled trial.
BACKGROUND
Coronary microvascular dysfunction is frequently seen in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. Previous studies have suggested that the administration of intravenous adenosine resulted in an improvement of myocardial perfusion and a reduction in infarct size. Intracoronary adenosine (bolus of 30 to 60 microg) is a guideline-recommended therapy to improve myocardial reperfusion. The effect of intracoronary adenosine during primary percutaneous coronary intervention has not been investigated in a large randomized trial.


RESULTS
Patients presenting with acute ST-elevation myocardial infarction were randomized to 2 bolus injections of intracoronary adenosine (2 x 120 microg in 20 mL NaCl) or placebo (2 x 20 mL NaCl). The first bolus injection was given after thrombus aspiration and the second after stenting of the infarct-related artery. The primary end point was the incidence of residual ST-segment deviation <0.2 mV, 30 to 60 minutes after percutaneous coronary intervention. Secondary end points were ST-segment elevation resolution, myocardial blush grade, Thrombolysis in Myocardial Infarction flow on the angiogram after percutaneous coronary intervention, enzymatic infarct size, and clinical outcome at 30 days. A total of 448 patients were randomized to intracoronary adenosine (N=226) or placebo (N=222). The incidence of residual ST-segment deviation <0.2 mV did not differ between patients randomized to adenosine or placebo (46.2% versus 52.2%, P=NS). In addition, there were no significant differences in secondary outcome measures.


CONCLUSIONS
In this randomized placebo controlled trial enrolling 448 patients with ST-elevation myocardial infarction, administration of intracoronary adenosine after thrombus aspiration and after stenting of the infarct-related artery did not result in improved myocardial perfusion.
Fokkema
Marieke L
ML
Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.l.fokkema@thorax.umcg.nl
Vlaar
Pieter J
PJ
Vogelzang
Mathijs
M
Gu
Youlan L
YL
Kampinga
Marthe A
MA
de Smet
Bart J
BJ
Jessurun
Gillian A
GA
Anthonio
Rutger L
RL
van den Heuvel
Ad F
AF
Tan
Eng-Shiong
ES
Zijlstra
Felix
F
D000241:Adenosine / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D015607:Stents; D017131:Thrombectomy; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D000241:Adenosine