Effect of high-dose intracoronary adenosine administration during primary percutaneous coronary intervention in acute myocardial infarction: a randomized controlled trial

Circ Cardiovasc Interv. 2009 Aug;2(4):323-9. doi: 10.1161/CIRCINTERVENTIONS.109.858977.109.858977. Epub 2009 Jul 22.

Abstract

Background: Coronary microvascular dysfunction is frequently seen in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. Previous studies have suggested that the administration of intravenous adenosine resulted in an improvement of myocardial perfusion and a reduction in infarct size. Intracoronary adenosine (bolus of 30 to 60 microg) is a guideline-recommended therapy to improve myocardial reperfusion. The effect of intracoronary adenosine during primary percutaneous coronary intervention has not been investigated in a large randomized trial.

Methods and results: Patients presenting with acute ST-elevation myocardial infarction were randomized to 2 bolus injections of intracoronary adenosine (2 x 120 microg in 20 mL NaCl) or placebo (2 x 20 mL NaCl). The first bolus injection was given after thrombus aspiration and the second after stenting of the infarct-related artery. The primary end point was the incidence of residual ST-segment deviation <0.2 mV, 30 to 60 minutes after percutaneous coronary intervention. Secondary end points were ST-segment elevation resolution, myocardial blush grade, Thrombolysis in Myocardial Infarction flow on the angiogram after percutaneous coronary intervention, enzymatic infarct size, and clinical outcome at 30 days. A total of 448 patients were randomized to intracoronary adenosine (N=226) or placebo (N=222). The incidence of residual ST-segment deviation <0.2 mV did not differ between patients randomized to adenosine or placebo (46.2% versus 52.2%, P=NS). In addition, there were no significant differences in secondary outcome measures.

Conclusions: In this randomized placebo controlled trial enrolling 448 patients with ST-elevation myocardial infarction, administration of intracoronary adenosine after thrombus aspiration and after stenting of the infarct-related artery did not result in improved myocardial perfusion.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adenosine / administration & dosage*
  • Adenosine / adverse effects
  • Aged
  • Angioplasty, Balloon, Coronary* / instrumentation
  • Coronary Angiography
  • Coronary Circulation / drug effects*
  • Drug Administration Schedule
  • Female
  • Humans
  • Injections
  • Male
  • Microcirculation / drug effects*
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / therapy*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prospective Studies
  • Stents
  • Thrombectomy
  • Time Factors
  • Treatment Outcome
  • Vasodilator Agents / administration & dosage*
  • Vasodilator Agents / adverse effects

Substances

  • Platelet Aggregation Inhibitors
  • Vasodilator Agents
  • Adenosine