title: High-dose intracoronary adenosine for myocardial salvage in patients with acute ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Previous studies have suggested that intravenous administration of adenosine improves myocardial reperfusion and reduces infarct size in ST-elevation myocardial infarction (STEMI) patients. Intracoronary administration of adenosine has shown conflicting results.
  
  
  RESULTS
  In a prospective, single-centre, double-blind, placebo-controlled clinical study, we assessed whether selective intracoronary administration of adenosine distal to the occlusion site immediately before initial balloon inflation results in myocardial salvage and decreased microvascular obstruction (MVO) as assessed with cardiac magnetic resonance imaging (MRI). Using a combination of T(2)-weighted and contrast-enhanced sequences, myocardial salvage index (MSI) was defined as the percentage of the area at risk that did not become necrotic. We randomized 112 patients presenting with STEMI within 12 h from symptom onset to selective intracoronary administration of adenosine 4 mg or matching placebo. In 100/110 (91%) patients receiving study drug, MRI was performed on Days 2-3. No significant difference in MSI was found between adenosine- and placebo-treated patients: 41.3% (20.8, 66.7) vs. 47.8% (39.8, 60.9) [median (Q1, Q3)] (P = 0.52). The extent of MVO was comparable in both groups, with a trend favouring the placebo group: 2.4 g (0.0, 6.8) vs. 5.9 g (0.0, 12.8) after adenosine (P = 0.07). TIMI flow grade, TIMI frame count, myocardial blush grade, and ST-segment resolution after primary percutaneous coronary intervention were similar between groups. After 4 months, infarct size was similar in both treatment groups.
  
  
  CONCLUSIONS
  We found no evidence that selective high-dose intracoronary administration of adenosine distal to the occlusion site of the culprit lesion in STEMI patients results in incremental myocardial salvage or a decrease in microvascular obstruction.
authors.affiliation: Department of Cardiovascular Medicine, University Hospitals Leuven, Gasthuisberg, Herestraat 49, Leuven, Belgium. walter.desmet@uzleuven.be
authors.forename: Walter
authors.initials: W
authors.lastname: Desmet
authors.forename: Jan
authors.initials: J
authors.lastname: Bogaert
authors.forename: Christophe
authors.initials: C
authors.lastname: Dubois
authors.forename: Peter
authors.initials: P
authors.lastname: Sinnaeve
authors.forename: Tom
authors.initials: T
authors.lastname: Adriaenssens
authors.forename: Christos
authors.initials: C
authors.lastname: Pappas
authors.forename: Javier
authors.initials: J
authors.lastname: Ganame
authors.forename: Steven
authors.initials: S
authors.lastname: Dymarkowski
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssens
authors.forename: Ann
authors.initials: A
authors.lastname: Belmans
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000378:metabolism; D017023:Coronary Angiography; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D015415:Biomarkers; D014665:Vasodilator Agents; D000241:Adenosine