High dose adenosine for suboptimal myocardial reperfusion after primary PCI: A ramdomized placebo-controlled pilot study

Martin G. Stoel (Corresponding Author), Koen M.J. Marques, Carel C. de Cock, Jean G.F. Bronzwaer, Clemens von Birgelen, Felix Zijlstra

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    Abstract

    OBJECTIVES: This study was designed to investigate the influence of high dose intracoronary adenosine on persistent ST-segment elevation after primary percutaneous coronary intervention (PCI).

    BACKGROUND: After successful PCI for acute myocardial infarction 40-50% of patients show persistent ST-segment elevation indicating suboptimal myocardial reperfusion. Adenosine has been studied to ameliorate reperfusion and is frequently used in a variety of doses, but there are no prospective studies to support its use for treatment of suboptimal reperfusion.

    METHODS: We conducted a blinded, randomized, and placebo-controlled study with high dose intracoronary adenosine in 51 patients with <70% ST-segment resolution (STRes) after successful primary PCI. All patients were treated with stents and abciximab.RESULTS: Immediately after adenosine, significantly more patients showed optimal (>70%) STRes compared with placebo (33% versus 9%, P < 0.05). Mean STRes was higher after adenosine (35.4% versus 23.0%, P < 0.05). In addition, TIMI frame count was significant lower (15.7 versus 30.2, P < 0.005), Myocardial Blush Grade was higher (2.7 versus 2.0, P < 0.05) and resistance index was lower in the adenosine group (0.70 versus 1.31 mm Hg per ml/min, P < 0.005).

    CONCLUSIONS: Intracoronary adenosine accelerates recovery of microvascular perfusion in case of persistent ST segment elevation after primary PCI.

    Original languageEnglish
    Pages (from-to)283-289
    Number of pages7
    JournalCatheterization and cardiovascular interventions
    Volume71
    Issue number3
    DOIs
    Publication statusPublished - 2008

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    Keywords

    • METIS-254337
    • Adenosine
    • Myocardial infarction
    • Primary percutaneous coronary intervention
    • ST-segment resolution
    • Reperfusion

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