Key result
Intracoronary adenosine or SNP during primary PCI fails to reduce infarct size, while adenosine increases MACE.
Why the study?
Microvascular obstruction following PPCI for STEMI contributes to infarct expansion, LV remodelling, and worse outcomes, prompting investigation into whether IC adenosine or SNP reduces infarct size or MVO.
Does intra-coronary high-dose adenosine or sodium nitroprusside reduce infarct size on CMR in STEMI patients undergoing primary PCI?
Population
247 STEMI patients with single vessel disease presenting within 6 h of symptom onset
Comparison
IC adenosine vs IC SNP vs standard PPCI
Design
Prospective, open-label, multicentre randomized trial with blinded endpoints
Follow-up
6 months
Authors
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Avoid intra-coronary adenosine or SNP in primary PCI for STEMI; confirms no infarct size benefit and leaves open effective MVO therapies.
RCT (n=247)
Open-label
1:1:1
Yes
Does intra-coronary high-dose adenosine or sodium nitroprusside reduce infarct size on CMR in STEMI patients undergoing primary PCI?
Absolute Event Rate: 10.1% vs 8.3%
p-value: p=0.062
High-dose intra-coronary adenosine or sodium nitroprusside during primary PCI for STEMI does not reduce infarct size or microvascular obstruction, and adenosine may increase the risk of adverse clinical outcomes.
Nazir et al. (2016) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=247). Intra-coronary high-dose adenosine or sodium nitroprusside (SNP) vs. Standard PPCI was evaluated on Infarct size % LV mass (%LVM) on CMR undertaken 24-96 h after PPCI (p=0.062). Intra-coronary adenosine or SNP during primary PCI did not reduce infarct size vs control (10.1% and 10.0% vs 8.3%; P=0.062 and P=0.160), while adenosine increased 6-month MACE.
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