title: Adenosine improves post-procedural coronary flow but not clinical outcomes in patients with acute coronary syndrome: a meta-analysis of randomized trials.
abstract: OBJECTIVE
  Adjunctive therapy with adenosine has been shown to improve coronary flow in patients with acute coronary syndromes (ACS); it is unclear, however, whether adenosine can effectively reduce adverse clinical events. The aim of our study was to perform a meta-analysis of all randomized controlled trials (RCTs) investigating angiographic and clinical outcomes in ACS patients undergoing PCI or thrombolysis and receiving adjunctive adenosine therapy vs. placebo.
  
  
  METHODS
  Medline/CENTRAL/EMBASE and Google Scholar database were scanned. The meta-analysis included ten RCTs (N=3821). All-cause mortality was chosen as primary endpoint. Secondary endpoints were re-infarction (MI), heart failure (HF) symptoms (NYHA class III/IV), no-reflow (defined as TIMI 0 flow) and >50% ST-resolution.
  
  
  RESULTS
  Adenosine compared to placebo was associated with a significant reduction of post-procedural no-reflow (OR [95% CI]=0.25 [0.08-0.73], p=0.01); however, at a median follow-up of 6 months, prior treatment with adenosine did not confer significant benefits in terms of reduction of mortality (OR(Fixed) [95% CI]=0.87 [0.69-1.09], p=0.23), as well as re-MI (p=0.80), HF symptoms (p=0.44) and ST-resolution (p=0.09). Separate analyses conducted in the subgroups of ST-elevation MI patients treated with either PCI or thrombolysis confirmed the findings found in the overall population.
  
  
  CONCLUSIONS
  This meta-analysis shows that adenosine adjunctive therapy does not improve survival nor reduce the rates of re-MI and HF symptoms in patients with ACS treated with PCI or thrombolysis. The beneficial effect on post-procedural coronary flow was not associated with consistent advantages on clinical outcomes.
authors.affiliation: Interventional Cardio-Angiology Unit, GVM Care and Research, Cotignola, RA, Italy. eliano.navarese@alice.it
authors.forename: Eliano Pio
authors.initials: EP
authors.lastname: Navarese
authors.forename: Antonino
authors.initials: A
authors.lastname: Buffon
authors.forename: Felicita
authors.initials: F
authors.lastname: Andreotti
authors.forename: Paul Alfred
authors.initials: PA
authors.lastname: Gurbel
authors.forename: Marek
authors.initials: M
authors.lastname: Kozinski
authors.forename: Aldona
authors.initials: A
authors.lastname: Kubica
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Jacek
authors.initials: J
authors.lastname: Kubica
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000241:Adenosine / Q000627:therapeutic use*; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000241:Adenosine