title: Intracoronary adenosine administered during aortocoronary vein graft interventions may reduce the incidence of no-reflow phenomenon. A pilot randomised trial.
abstract: BACKGROUND
  The results of percutaneous coronary intervention (PCI) for saphenous vein graft (SVG) disease are limited by distal embolisation and no-reflow which occurs in 10-43% of cases.
  
  
  OBJECTIVE
  To examine the role of a new protocol of adenosine administration during PCI in SVG on immediate angiographic results and clinical course.
  
  
  METHODS
  A prospective, single-centre, randomised placebo-controlled pilot trial in 32 consecutive patients after coronary artery bypass graft (aged 71 ± 12 years, 22 male) with stable and unstable angina (CCS II-IV), who were admitted to our hospital for SVG PCI, was conducted. Patients were randomised to two groups. Group A (16 patients) received two times adenosine (2 mg + 2 mg) to the SVG during PCI procedure, and Group B (16 patients) received a placebo.
  
  
  RESULTS
  No reflow was observed in one (6.25%) patient in the adenosine group and six (37.5%) patients in the placebo group (p = 0.0325). TIMI 3 flow (94% vs. 63%; p = 0.0322) and corrected TIMI frame count < 28 (94% vs. 63%; p = 0.0322) at the end of the procedure were better in patients who received adenosine. Myocardial blush grade 2 and 3 at the end of th eprocedure was observed in 15 patients in the adenosine group and ten patients in the placebo group (p = 0.083). A trend toward a lower rate of myocardial infarctions in the adenosine group was observed (6% vs. 25%; p = 0.144).
  
  
  CONCLUSIONS
  Adenosine injections may be effective in preventing no-reflow in the setting of PCI of SVG. Adenosine administration seems to be associated with a more favourable clinical course.
authors.affiliation: I Klinika Katedry Kardiologii Uniwersytet Medyczny Poznań. 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: Stefan
authors.initials: S
authors.lastname: Grajek
mesh_terms: D000241:Adenosine / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D054318:No-Reflow Phenomenon / Q000188:drug therapy*; D062645:Percutaneous Coronary Intervention; D055031:Primary Graft Dysfunction / Q000188:drug therapy*; D011446:Prospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine