title: Impact of Intracoronary Adenosine on Myonecrosis in Patients with Unstable Angina Pectoris Undergoing Percutaneous Coronary Intervention.
abstract: BACKGROUND
  In this study, we aimed to investigate the impact of prophylactic intracoronary adenosine administered during percutaneous coronary intervention (PCI) due to unstable angina pectoris on myonecrosis by measuring post-procedural levels of cardiac troponin I (cTnI) and creatine kinase-myocardial band (CK-MB).
  
  
  METHODS
  A total of 122 patients with unstable angina undergoing PCI were included in this single-center, double-blind, randomized study. The patients were randomly allocated to adenosine and placebo groups. In the adenosine group, a single-dose of intracoronary adenosine (100 μg for the right coronary artery and 150 μg for the left coronary artery) was administered. Primary endpoint was post-PCI myonecrosis, which was defined as abnormal levels of periprocedural cTnI. Secondary endpoints were defined as elevated cTnI levels [5 × upper limit of normal (ULN)], abnormal CK-MB levels, angiographic coronary flow measured by Thrombolysis In Myocardial Infarction (TIMI) frame count (TFC), the cumulative incidence of in-hospital death and in-hospital urgent target vessel revascularization (TVR).
  
  
  RESULTS
  Clinical and angiographic characteristics of both adenosine (61 patients, 61 ± 9 years) and placebo (61 patients, 59 ± 10 years) groups were similar (p > 0.05 for all). Post-procedural abnormal cTnI levels in the adenosine group were significantly lower than the placebo group (32 % vs. 55 %, p: 0.011). cTnI >5 × ULN (21 % vs. 31 %, p: 0.217) and abnormal CK-MB levels (11 % vs. 19 %, p: 0.263) were similar in both groups. Post-procedural TFCs in the adenosine group were significantly lower than the placebo group (24 ± 4 vs. 27 ± 5, p: 0.004). In-hospital events including death and urgent TVR were not observed in either group.
  
  
  CONCLUSIONS
  Intracoronary administration of single-dose adenosine in patients with unstable angina undergoing PCI is associated with decreased periprocedural myonecrosis and improved coronary blood flow.
authors.affiliation: Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey. filizkizilirmak@hotmail.com.
authors.forename: Filiz
authors.initials: F
authors.lastname: Kizilirmak
authors.affiliation: Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey.
authors.forename: Haci Murat
authors.initials: HM
authors.lastname: Gunes
authors.affiliation: Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey.
authors.forename: Gultekin Gunhan
authors.initials: GG
authors.lastname: Demir
authors.affiliation: Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey.
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gokdeniz
authors.affiliation: Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey.
authors.forename: Ekrem
authors.initials: E
authors.lastname: Guler
authors.affiliation: Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey.
authors.forename: Beytullah
authors.initials: B
authors.lastname: Cakal
authors.affiliation: Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey.
authors.forename: Mehmet Onur
authors.initials: MO
authors.lastname: Omaygenç
authors.affiliation: Kartal Kosuyolu Research and Education Hospital, Istanbul University, Istanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Yılmaz
authors.affiliation: Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey.
authors.forename: Umeyir
authors.initials: U
authors.lastname: Savur
authors.affiliation: Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey.
authors.forename: Irfan
authors.initials: I
authors.lastname: Barutcu
keywords: Adenosine; Myonecrosis; Percutaneous coronary intervention; Unstable angina