title: Intracoronary injection of adenosine before reperfusion in patients with ST-segment elevation myocardial infarction: a randomized controlled clinical trial.
abstract: BACKGROUND
  The effect of intracoronary adenosine (ADO) on ST-segment elevation myocardial infarction (STEMI) size and adverse remodeling is not well established.
  
  
  METHODS
  In a double-blind trial, 201 patients with STEMI were randomized to receive percutaneous coronary intervention (PCI) within 6 hours of symptom onset, 4.5mg ADO or saline immediately prior to reperfusion. Primary end-point: percentage of total myocardial necrotic mass by cardiac magnetic resonance (CMR) 2-7 days post-reperfusion. Secondary end-points: changes in left ventricular volumes and ejection fraction (LVEF) at baseline and at 6 months.
  
  
  RESULTS
  Baseline CMR could not be performed in 20 patients. Overall, no significant differences were observed between ADO and placebo regarding infarct size (20.8% vs. 22.5%; p=0.40). However, infarct size was significantly reduced (19.4% vs. 25.7%; p for interaction=0.031) in those with ischemia duration below the median (200 min). CMR at 6 months, performed in 138 patients, did not show statistically significant differences between groups in the rate of LVEF increase (3.3 units (SD 9.6) in ADO group vs. 1.5 units (SD 9) in placebo group; p=0.25). In the subgroup analysis, among patients with ischemia time below 200 min, the increase in LVEF was slightly higher with ADO (3.59% vs. 0.43%; p for interaction=0.06).
  
  
  CONCLUSIONS
  Although our study failed to demonstrate that intracoronary administration of ADO prior to PCI limits infarct size, in patients receiving early PCI ADO might enhance myocardial salvage and has a favorable effect on LVEF evolution, which may help to reconcile apparently contradictory results of previous studies.
  
  
  BACKGROUND
  http://clinicaltrials.gov (NCT00781404).
authors.affiliation: Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: dgdorado@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
authors.affiliation: Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: García-del-Blanco
authors.affiliation: Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Imanol
authors.initials: I
authors.lastname: Otaegui
authors.affiliation: Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Rodríguez-Palomares
authors.affiliation: Institute for Diagnostic Imaging (IDI), Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Pineda
authors.affiliation: Institute for Heart Science (ICICOR), Clinic University Hospital of Valladolid, Valladolid, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Gimeno
authors.affiliation: Cardiology Department, University Hospital Virgen de la Macarena, Seville, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ruiz-Salmerón
authors.affiliation: Cardiology Department, University General Hospital Gregorio Marañón , Department of Cardiology, Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Elizaga
authors.affiliation: Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Cardiology Department, University General Hospital Gregorio Marañón , Department of Cardiology, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernandez-Avilés
authors.affiliation: Institute for Heart Science (ICICOR), Clinic University Hospital of Valladolid, Valladolid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: San-Román
authors.affiliation: Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain; Research Center for Epidemiology and Public Health of the Carlos III Health Institute (CIBERESP), Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-González
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000517:prevention & control*; D015425:Myocardial Reperfusion / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: Adenosine; Infarct remodeling; Infarct size; Reperfusion injury