Key result
High-dose intracoronary adenosine fails to improve myocardial salvage index vs placebo in STEMI patients.
Why the study?
Previous studies suggested intravenous adenosine improves myocardial reperfusion and reduces infarct size in STEMI, but intracoronary administration results were conflicting.
Does selective high-dose intracoronary adenosine improve myocardial salvage in patients with STEMI?
RCT (n=112)
Double-blind
randomized
No
Does selective high-dose intracoronary adenosine improve myocardial salvage in patients with STEMI?
Absolute Event Rate: 41.3% vs 47.8%
p-value: p=0.52
High-dose intracoronary adenosine administered distal to the culprit lesion before primary PCI does not improve myocardial salvage or reduce microvascular obstruction in STEMI patients.
Does not support routine high-dose intracoronary adenosine in STEMI; challenges prior smaller studies and narrows adjunctive cardioprotection research.
AIMS: Previous studies have suggested that intravenous administration of adenosine improves myocardial reperfusion and reduces infarct size in ST-elevation myocardial infarction (STEMI) patients. Intracoronary administration of adenosine has shown conflicting results. METHODS AND RESULTS: In a prospective, single-centre, double-blind, placebo-controlled clinical study, we assessed whether selective intracoronary administration of adenosine distal to the occlusion site immediately before initial balloon inflation results in myocardial salvage and decreased microvascular obstruction (MVO) as assessed with cardiac magnetic resonance imaging (MRI). Using a combination of T(2)-weighted and contrast-enhanced sequences, myocardial salvage index (MSI) was defined as the percentage of the area at risk that did not become necrotic. We randomized 112 patients presenting with STEMI within 12 h from symptom onset to selective intracoronary administration of adenosine 4 mg or matching placebo. In 100/110 (91%) patients receiving study drug, MRI was performed on Days 2-3. No significant difference in MSI was found between adenosine- and placebo-treated patients: 41.3% (20.8, 66.7) vs. 47.8% (39.8, 60.9) [median (Q1, Q3)] (P = 0.52). The extent of MVO was comparable in both groups, with a trend favouring the placebo group: 2.4 g (0.0, 6.8) vs. 5.9 g (0.0, 12.8) after adenosine (P = 0.07). TIMI flow grade, TIMI frame count, myocardial blush grade, and ST-segment resolution after primary percutaneous coronary intervention were similar between groups. After 4 months, infarct size was similar in both treatment groups. CONCLUSION: We found no evidence that selective high-dose intracoronary administration of adenosine distal to the occlusion site of the culprit lesion in STEMI patients results in incremental myocardial salvage or a decrease in microvascular obstruction.
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Desmet et al. (2010) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=112). Intracoronary adenosine vs. Placebo was evaluated on Myocardial salvage index (MSI) (p=0.52). Selective high-dose intracoronary administration of adenosine did not significantly improve myocardial salvage index compared to placebo in STEMI patients (41.3% vs 47.8%; P=0.52).
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