Abstract 12720: The Role of Intracoronary Adenosine in Prevention of Microvascular Reperfusion Injury in Patients Undergoing Primary Percutaneous Coronary Intervention During Acute Myocardial Infarction — Results of Single-center Randomized, Placebo-controlled Trial.
Background: Primary angioplasty is the best treatment of acute myocardial infarction but fails to achieve adequate myocardial reperfusion in about one-third of patients, despite TIMI grade 3 flow. The benefits of vessel recanalization are limited by reperfusion damage. Drug treatment aimed at reducing the no-reflow phenomenon may improve myocardial salvage, thus preventing left ventricular remodelling. In animal models, adenosine limits reperfusion injury, reducing infarct size and improving ventricular function. Also limited data from some human studies confirm beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty.
Objectives: The aim of our study was to examine the role of new, simple protocol of intracoronary adenosine administration performed during primary angioplasty on immediate angiographic results.
Material and Methods: A prospective, single-center, randomized placebo-controlled trial in 70 consecutive patients (64±14 years, 54 male) with acute myocardial infarction with ST segment elevation undergoing emergency PCI was conducted. Patients were randomized to 2 groups. Group A (n=35) received two times intracoronary adenosine (1–2mg) with hand injection through the guiding catheter: immediately after crossing the lesion of the infarct related artery with guidewire and then after first balloon inflation. Group B (n=35) received placebo. Baseline clinical and angiographic characteristics of two groups were similar.
Results: PCI resulted in TIMI 3 flow after procedure in 32 patients (91.4%) in adenosine group and 27 patients (77.1%) in placebo group (p<0.05). Myocardial blush grade 3 at the end of procedure was observed in 23 patients (65.7%) in adenosine group and 13 patients (37.1%) in placebo group (p<0.01). Resolution of ST segment elevation (>50%) was more frequently observed in adenosine than in placebo group — 27 (77%) vs 15 (43%) patients respectively (p<0.01). Peak creatine kinase and CK-MB were similar in two groups.
Conclusions: Intracoronary adenosine seems to improves angiographic results and prevents microvascular reperfusion injury in patients with acute myocardial infarction with ST segment elevation undergoing percutaneous coronary intervention.
- © 2010 by American Heart Association, Inc.