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Published on: February 3, 2021
Effect of high-dose intracoronary adenosine administration during primary percutaneous coronary intervention in acute
Marieke L Fokkema1, Pieter J Vlaar, Mathijs Vogelzang
1Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.l.fokkema@thorax.umcg.nl
Insights
Intracoronary adenosine did not improve myocardial perfusion in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. This large trial found no significant differences in key outcomes between adenosine and placebo groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- Coronary microvascular dysfunction is common post-primary percutaneous coronary intervention for ST-elevation myocardial infarction.
- Intravenous adenosine has shown benefits in improving myocardial perfusion and reducing infarct size.
- Intracoronary adenosine is guideline-recommended for improving myocardial reperfusion, but its effect in a large randomized trial setting is unclear.
Purpose of the Study:
- To investigate the efficacy of intracoronary adenosine in improving myocardial perfusion during primary percutaneous coronary intervention for ST-elevation myocardial infarction.
- To evaluate the impact of intracoronary adenosine on residual ST-segment deviation and other markers of reperfusion.
Main Methods:
- A large randomized placebo-controlled trial involving 448 patients with ST-elevation myocardial infarction.
- Patients received two bolus injections of intracoronary adenosine (2 x 120 microg) or placebo (2 x 20 mL NaCl).
- The first bolus was administered after thrombus aspiration, and the second after stenting of the infarct-related artery.
Main Results:
- The primary endpoint, residual ST-segment deviation <0.2 mV, did not differ significantly between the adenosine and placebo groups (46.2% vs 52.2%, P=NS).
- No significant differences were observed in secondary outcome measures, including ST-segment elevation resolution, myocardial blush grade, and Thrombolysis in Myocardial Infarction flow.
- Enzymatic infarct size and 30-day clinical outcomes also showed no significant improvement with intracoronary adenosine.
Conclusions:
- Intracoronary adenosine administration, given as two bolus injections after thrombus aspiration and stenting, did not improve myocardial perfusion in patients with ST-elevation myocardial infarction.
- The findings suggest that intracoronary adenosine may not be effective in enhancing reperfusion outcomes in this specific clinical setting.
Background:
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.
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