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Effect of high-dose intracoronary adenosine administration during primary percutaneous coronary intervention in acute myocardial infarction: a randomized controlled trial Fokkema ML; Vlaar PJ; Vogelzang M; Gu YL; Kampinga MA; de Smet BJ; Jessurun GA; Anthonio RL; van den Heuvel AF; Tan ES; Zijlstra FCirc Cardiovasc Interv 2009[Aug]; 2 (4): 323-9BACKGROUND: Coronary microvascular dysfunction is frequently seen in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. Previous studies have suggested that the administration of intravenous adenosine resulted in an improvement of myocardial perfusion and a reduction in infarct size. Intracoronary adenosine (bolus of 30 to 60 microg) is a guideline-recommended therapy to improve myocardial reperfusion. The effect of intracoronary adenosine during primary percutaneous coronary intervention has not been investigated in a large randomized trial. METHODS AND RESULTS: Patients presenting with acute ST-elevation myocardial infarction were randomized to 2 bolus injections of intracoronary adenosine (2 x 120 microg in 20 mL NaCl) or placebo (2 x 20 mL NaCl). The first bolus injection was given after thrombus aspiration and the second after stenting of the infarct-related artery. The primary end point was the incidence of residual ST-segment deviation <0.2 mV, 30 to 60 minutes after percutaneous coronary intervention. Secondary end points were ST-segment elevation resolution, myocardial blush grade, Thrombolysis in Myocardial Infarction flow on the angiogram after percutaneous coronary intervention, enzymatic infarct size, and clinical outcome at 30 days. A total of 448 patients were randomized to intracoronary adenosine (N=226) or placebo (N=222). The incidence of residual ST-segment deviation <0.2 mV did not differ between patients randomized to adenosine or placebo (46.2% versus 52.2%, P=NS). In addition, there were no significant differences in secondary outcome measures. CONCLUSIONS: In this randomized placebo controlled trial enrolling 448 patients with ST-elevation myocardial infarction, administration of intracoronary adenosine after thrombus aspiration and after stenting of the infarct-related artery did not result in improved myocardial perfusion.|*Angioplasty, Balloon, Coronary/instrumentation[MESH]|Adenosine/*administration & dosage/adverse effects[MESH]|Aged[MESH]|Coronary Angiography[MESH]|Coronary Circulation/*drug effects[MESH]|Drug Administration Schedule[MESH]|Female[MESH]|Humans[MESH]|Injections[MESH]|Male[MESH]|Microcirculation/*drug effects[MESH]|Middle Aged[MESH]|Myocardial Infarction/diagnostic imaging/drug therapy/physiopathology/*therapy[MESH]|Platelet Aggregation Inhibitors/therapeutic use[MESH]|Prospective Studies[MESH]|Stents[MESH]|Thrombectomy[MESH]|Time Factors[MESH]|Treatment Outcome[MESH]|Vasodilator Agents/*administration & dosage/adverse effects[MESH] |
