Key result
High-dose intracoronary adenosine protocol linked to a ~6% rate of no-reflow during SVG PCI.
Why the study?
Saphenous vein graft PCI carries a high risk of slow or no-reflow leading to higher MACE rates, but evidence on high-dose intracoronary adenosine for its prevention remains limited.
Does a high-dose intracoronary adenosine protocol prevent slow or no-reflow and improve major adverse cardiovascular events in patients undergoing saphenous vein graft PCI without embolic protection devices?
Cohort (n=171)
No
Does a high-dose intracoronary adenosine protocol prevent slow or no-reflow and improve major adverse cardiovascular events in patients undergoing saphenous vein graft PCI without embolic protection devices?
High-dose intracoronary adenosine administered prior to balloon or stent inflation during saphenous vein graft PCI without embolic protection devices is safe and associated with very low rates of slow/no-reflow and favorable 1-year clinical outcomes.
Adenosine protocol was associated with low no-reflow in SVG PCI; leaves open randomized confirmation versus controls.
Abstract Background Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) carries a high-risk of slow or no-reflow (SNR)—up to 15% in stable ischemia and 29% in acute coronary syndrome (ACS)—leading to higher major adverse cardiovascular event rates. Evidence on high-dose intracoronary adenosine for SNR prevention remains limited. Methods We analyzed 171 patients with stable ischemic heart disease or ACS who underwent SVG PCI without embolic protection devices from 2010 to 2024 at our center. All received 200 to 400 μg intracoronary adenosine within 30 seconds just prior to each balloon or stent inflation, and post-PCI outcomes were evaluated. Results Of 171 patients, 71.2% were mene, and 83% presented with ACS. Pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow was <3 in 41.1% of the patients. Using the adenosine protocol, no-reflow occurred in 1.2% and slow flow in 4.7%. SNR incidence was 0% in patients with pre-PCI TIMI flow 3 vs higher in those with pre-PCI TIMI <3 (P = .01). Major adverse cardiovascular event rates were 2.3%, 4.6%, and 8.7% at in-hospital, 30-day, and 1-year follow-up, respectively, with significantly better outcomes in the TIMI 3 group (P = .020). Target vessel revascularization was 3.5% at both 30 days and 1 year. Conclusions High-dose intracoronary adenosine protocol described in this study markedly reduced the incidence of SNR and was associated with improved short- and long-term outcomes in patients undergoing SVG PCI.
No takes yet. Share an insight, caveat, or question.
Tahirkheli et al. (2026) conducted a cohort in Saphenous vein graft (SVG) stenosis in stable ischemic heart disease or acute coronary syndrome (n=171). Intracoronary adenosine was evaluated on Incidence of slow or no-reflow (SNR). A high-dose intracoronary adenosine protocol administered prior to each balloon or stent inflation resulted in a low 5.9% incidence of slow or no-reflow in patients undergoing saphenous vein graft PCI.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: