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Published on: April 25, 2014
Intracoronary adenosine improves myocardial perfusion in late reperfused myocardial infarction
Feng Tian1, Yun-Dai Chen, Shu-zheng Lü
1Department of Cardiology, Beijing Anzhen Hospital of Capital University Medical Science, Beijing 100029, China.
Insights
Intracoronary adenosine improved myocardial microvascular perfusion and clinical outcomes in patients with late reperfused myocardial infarction (MI). This treatment enhanced blood flow and reduced adverse cardiac events compared to saline.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Myocardial perfusion is critical for clinical outcomes in myocardial infarction (MI).
- Adenosine is known to improve perfusion in acute MI, but its effect on late-stage MI is less understood.
- Limited data exist on the efficacy of adenosine in improving myocardial perfusion in patients with late reperfused MI.
Purpose of the Study:
- To quantitatively assess the effectiveness of intracoronary adenosine in enhancing myocardial perfusion in late reperfused MI patients.
- To evaluate the impact of adenosine on myocardial microvascular function using myocardial contrast echocardiography (MCE).
- To determine if adenosine improves clinical outcomes in the follow-up period after percutaneous coronary intervention (PCI).
Main Methods:
- Twenty-six patients with anterior wall MI (3-12 weeks post-infarction) were randomized into adenosine (n=12) and normal saline (n=14) groups.
- Adenosine or saline was administered during PCI before stent implantation.
- Myocardial contrast echocardiography (MCE) with Sonovue contrast was performed before and 30 minutes after PCI to assess perfusion.
- Video densitometry and contrast-filled area were quantified to measure microvascular function.
Main Results:
- Adenosine group showed significantly better perfusion in infarct-related artery segments compared to the saline group (P < 0.05).
- The area of improved perfusion was significantly larger in the adenosine group post-PCI ((1.56 +/- 0.60) cm(2) vs (1.02 +/- 0.56) cm(2), P < 0.05).
- Adenosine treatment led to a significant improvement in video densitometry and a reduction in major adverse cardiac events (MACE) during 30-day follow-up (0 vs 3 MACE).
Conclusions:
- Intracoronary adenosine effectively improves myocardial microvascular perfusion in patients with late reperfused MI (3-12 weeks post-AMI).
- Enhanced microvascular perfusion is associated with improved clinical outcomes in the follow-up period.
- Myocardial microvascular perfusion is a significant predictor of clinical events in post-MI patients.
Background:
Myocardial perfusion associates with clinical syndromes and prognosis. Adenosine could improve myocardial perfusion of acute myocardial infarction within 6 hours, but few data are available on late perfusion of myocardial infarction (MI). This study aimed at quantitatively evaluating the value of intracoronary adenosine improving myocardial perfusion in late reperfused MI with myocardial contrast echocardiography (MCE).
Methods:
Twenty-six patients with anterior wall infarcts were divided randomly into 2 groups: adenosine group (n = 12) and normal saline group (n = 14). Their history of myocardial infarction was about 3 - 12 weeks. Adenosine or normal saline was given when the guiding wire crossed the lesion through percutaneous coronary intervention (PCI), then the balloon was dilated and stent (Cypher/Cypher select) was implanted at the lesion. Contrast pulse sequencing MCE with Sonovue contrast via the coronary route was done before PCI and 30 minutes after PCI. Video densitometry and contrast filled-blank area were calculated with the CUSQ off-line software. Heart function and cardiac events were followed up within 30 days.
Results:
Perfusion in the segments of the criminal occlusive coronary artery in the adenosine group was better than that in the saline group (5.71 +/- 0.29 vs 4.95 +/- 1.22, P < 0.05). Ischemic myocardial segment was deminished significantly after PCI, but the meliorated area was bigger in the adenosine group than in the saline group ((1.56 +/- 0.60) cm(2) vs (1.02 +/- 0.56) cm(2), P < 0.05). The video densitometry in critical segments was also improved significantly in the adenosine group (5.53 +/- 0.36 vs 5.26 +/- 0.35, P < 0.05). Left ventricular ejection fraction (LVEF) was improved in all patients after PCI, but EF was not significant between the two groups ((67 +/- 6)% vs (62 +/- 7)%, P > 0.05). There was no in-hospital or 30-day major adverse cardiac event (MACE) in the adenosine group but 3 MACE in the saline group in 30 days after PCI.
Conclusions:
Adenosine could improve myocardial microvascular perfusion in the late reopening of an occluded infarct related artery (3 to 12 weeks after AMI) and clinical outcome in the follow-up period, and myocardial microvascular perfusion is a powerful predictor of clinical events.
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