Key result
Adenosine cuts 6-month death or HF by ~30% vs placebo following early reperfusion.
Why the study?
The efficacy of adenosine versus placebo in acute anterior STEMI may depend on the timing of reperfusion therapy and reperfusion modality, which was unclear.
Does adenosine reduce the composite of death or CHF in patients with anterior STEMI undergoing reperfusion therapy?
RCT
Does adenosine reduce the composite of death or CHF in patients with anterior STEMI undergoing reperfusion therapy?
Absolute Event Rate: 12% vs 17.2%
p-value: p=0.022
Adenosine infusion administered as an adjunct to early reperfusion (<3.17 hours) in anterior STEMI may reduce mortality and heart failure events.
May support adenosine adjunct in early anterior STEMI reperfusion; leaves open randomized confirmation before practice change.
AIMS: The purpose of this analysis was to determine whether the efficacy of adenosine vs. placebo was dependent on the timing of reperfusion therapy in the second Acute Myocardial Infarction Study of Adenosine (AMISTAD-II). METHODS AND RESULTS: Patients presenting with ST-segment elevation anterior AMI were randomized to receive placebo vs. adenosine (50 or 70 microg/kg/min) for 3 h starting within 15 min of reperfusion therapy. In the present post hoc hypothesis generating study, the results were stratified according to the timing of reperfusion, i.e. > or = or < the median 3.17 h, and by reperfusion modality. In patients receiving reperfusion < 3.17 h, adenosine compared with placebo significantly reduced 1-month mortality (5.2 vs. 9.2%, respectively, P = 0.014), 6-month mortality (7.3 vs. 11.2%, P = 0.033), and the occurrence of the primary 6-month composite clinical endpoint of death, in-hospital CHF, or rehospitalization for CHF at 6 months (12.0 vs. 17.2%, P = 0.022). Patients reperfused beyond 3 h did not benefit from adenosine. CONCLUSION: In this post hoc analysis, 3 h adenosine infusion administered as an adjunct to reperfusion therapy within the first 3.17 h onset of evolving anterior ST-segment elevation AMI enhanced early and late survival, and reduced the composite clinical endpoint of death or CHF at 6 months.
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Kloner et al. (2006) conducted an RCT in ST-segment elevation anterior acute myocardial infarction. Adenosine vs. Placebo was evaluated on 6-month composite clinical endpoint of death, in-hospital CHF, or rehospitalization for CHF (p=0.022). In patients reperfused within 3.17 hours, a 3-hour adenosine infusion significantly reduced the 6-month composite of death or heart failure compared with placebo (12.0% vs. 17.2%, P=0.022).
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