title: New method of intracoronary adenosine injection to prevent microvascular reperfusion injury in patients with acute myocardial infarction undergoing percutaneous coronary intervention.
abstract: The aim of our study was to examine the role of a new, simple protocol of intracoronary adenosine administration performed during primary angioplasty on the immediate angiographic results and clinical course. A prospective, single-center, randomized, placebo-controlled trial of 70 consecutive patients (64 ± 14 years, 54 men) with acute myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary intervention (PCI) was conducted. Patients were randomized to 2 groups. Group 1 (n = 35) received intracoronary adenosine (1 to 2 mg) with a hand injection through the guiding catheter 2 times: immediately after crossing the lesion of the infarct-related artery with guidewire and then after the first balloon inflation. Group 2 (n = 35) received placebo. The baseline clinical and angiographic characteristics of the 2 groups were similar. Percutaneous coronary intervention resulted in Thrombolysis In Myocardial Infarction grade 3 flow after PCI in 32 patients (91.4%) in the adenosine group and 27 patients (77.1%) in the placebo group (p = 0.059). Myocardial blush grade 3 was observed at the end of PCI in 23 patients (65.7%) in the adenosine group and 13 (37.1%) in the placebo group (p < 0.05). Resolution of ST-segment elevation (> 50%) was more frequently observed in the adenosine than in the placebo group: 27 (77%) versus 15 (43%), respectively (p < 0.01). In conclusion, intracoronary adenosine administration improved the angiographic and electrocardiographic results in patients with acute myocardial infarction with ST-segment elevation undergoing PCI. Adenosine administration seemed to be associated with a more favorable clinical course.
authors.affiliation: First Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland. mgrygier@wp.pl
authors.forename: Marek
authors.initials: M
authors.lastname: Grygier
authors.forename: Aleksander
authors.initials: A
authors.lastname: Araszkiewicz
authors.forename: Maciej
authors.initials: M
authors.lastname: Lesiak
authors.forename: Magdalena
authors.initials: M
authors.lastname: Janus
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Kowal
authors.forename: Wlodzimierz
authors.initials: W
authors.lastname: Skorupski
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Pyda
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Mitkowski
authors.forename: Stefan
authors.initials: S
authors.lastname: Grajek
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003331:Coronary Vessels; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine