title: Adenosine as an Adjunct Therapy in ST Elevation Myocardial Infarction Patients: Myth or Truth?
abstract: Early reperfusion represents the key strategy in ST elevation myocardial infarction. However, reperfusion may induce myocardial damage due to the reperfusion myocardial injury, compromising the full potential of reperfusion therapy and accounting for unfavourable results in high risk patients. Adenosine seems to attenuate ischemia reperfusion injury, and thus represents a promising therapeutic option for treating such patients. However, previous randomized clinical trials have collectively failed to demonstrate whether adenosine can effectively reduce measures of myocardial injury and improve clinical outcome, despite its good basic evidence. The failure of such trials to show a real beneficial action may be in part related to specific factors other than adenosine's clinical efficacy. The purpose of this review is to explain the rationale for the use of adenosine as an adjunctive pharmacological cardio-protective agent following reperfusion of the ischemic myocardium, to address the weakness of previous trials and to summarize the current state of knowledge regarding the effect of adenosine administration on reperfusion myocardial injury in patients with myocardial infarction. Although some preclinical and clinical studies point towards the beneficial role of adenosine in the prevention and treatment of no-reflow phenomenon in myocardial infarction, many unanswered questions still remain, including the optimal clinical indication, mode, dosage, duration and timing of application, and the exact mechanisms leading to potential benefits. Clarifying these issues will depend on further properly designed, adequately powered and well conducted clinical trials, which will probably provide us with the definite answers.
authors.affiliation: Department of Cardiology, Asklepeion General Hospital, Athens, Greece. gksup@yahoo.gr.
authors.forename: George
authors.initials: G
authors.lastname: Kassimis
authors.affiliation: Department of Cardiology, University Hospital of Patras, Rion, Greece.
authors.forename: Periklis
authors.initials: P
authors.lastname: Davlouros
authors.affiliation: Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Niket
authors.initials: N
authors.lastname: Patel
authors.affiliation: Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: De Maria
authors.affiliation: Department of Cardiology, Asklepeion General Hospital, Athens, Greece.
authors.forename: Manolis S
authors.initials: MS
authors.lastname: Kallistratos
authors.affiliation: Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Rajesh K
authors.initials: RK
authors.lastname: Kharbanda
authors.affiliation: Department of Cardiology, Asklepeion General Hospital, Athens, Greece.
authors.forename: Athanasios J
authors.initials: AJ
authors.lastname: Manolis
authors.affiliation: Department of Cardiology, University Hospital of Patras, Rion, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.affiliation: Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Banning
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D009203:Myocardial Infarction / Q000188:drug therapy*; D015428:Myocardial Reperfusion Injury / Q000188:drug therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods
chemical_list: D002316:Cardiotonic Agents; D000241:Adenosine
keywords: Adenosine; Microvascular obstruction; No-reflow; Reperfusion injury; ST elevation myocardial infarction