Related Experiment Video
Updated: Apr 20, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Intracoronary injection of adenosine before reperfusion in patients with ST-segment elevation myocardial infarction:
David Garcia-Dorado1, Bruno García-del-Blanco1, Imanol Otaegui1
1Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
Insights
Intracoronary adenosine (ADO) did not significantly reduce ST-segment elevation myocardial infarction (STEMI) size overall. However, ADO may improve myocardial salvage and left ventricular ejection fraction (LVEF) in STEMI patients with shorter ischemia durations.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- The impact of intracoronary adenosine (ADO) on ST-segment elevation myocardial infarction (STEMI) size and adverse cardiac remodeling remains unclear.
- Previous studies have yielded conflicting results regarding ADO's efficacy in limiting infarct size.
Purpose of the Study:
- To investigate the effect of intracoronary adenosine (ADO) on infarct size and left ventricular remodeling in patients with STEMI.
- To evaluate ADO's potential to improve myocardial salvage and preserve left ventricular function post-STEMI.
Main Methods:
- A double-blind, randomized trial involving 201 STEMI patients undergoing percutaneous coronary intervention (PCI) within 6 hours of symptom onset.
- Patients received either ADO or a saline placebo immediately before reperfusion.
- Infarct size was assessed by cardiac magnetic resonance (CMR) 2-7 days post-reperfusion; left ventricular volumes and ejection fraction (LVEF) were measured at baseline and 6 months.
Main Results:
- No significant difference in overall infarct size was observed between the ADO and placebo groups (20.8% vs. 22.5%).
- A significant reduction in infarct size was noted in the ADO group for patients with ischemia duration below 200 minutes (19.4% vs. 25.7%).
- No statistically significant differences in LVEF increase were found at 6 months, though a trend towards greater LVEF improvement was seen in the ADO subgroup with shorter ischemia duration.
Conclusions:
- Intracoronary ADO administration prior to PCI did not limit overall infarct size in STEMI patients.
- ADO may enhance myocardial salvage and positively influence LVEF evolution in patients receiving early PCI, particularly those with shorter ischemia durations.
- These findings may help reconcile previous contradictory study results on ADO's role in STEMI management.
Background:
The effect of intracoronary adenosine (ADO) on ST-segment elevation myocardial infarction (STEMI) size and adverse remodeling is not well established.
Methods:
In a double-blind trial, 201 patients with STEMI were randomized to receive percutaneous coronary intervention (PCI) within 6 hours of symptom onset, 4.5mg ADO or saline immediately prior to reperfusion. Primary end-point: percentage of total myocardial necrotic mass by cardiac magnetic resonance (CMR) 2-7 days post-reperfusion. Secondary end-points: changes in left ventricular volumes and ejection fraction (LVEF) at baseline and at 6 months.
Results:
Baseline CMR could not be performed in 20 patients. Overall, no significant differences were observed between ADO and placebo regarding infarct size (20.8% vs. 22.5%; p=0.40). However, infarct size was significantly reduced (19.4% vs. 25.7%; p for interaction=0.031) in those with ischemia duration below the median (200 min). CMR at 6 months, performed in 138 patients, did not show statistically significant differences between groups in the rate of LVEF increase (3.3 units (SD 9.6) in ADO group vs. 1.5 units (SD 9) in placebo group; p=0.25). In the subgroup analysis, among patients with ischemia time below 200 min, the increase in LVEF was slightly higher with ADO (3.59% vs. 0.43%; p for interaction=0.06).
Conclusions:
Although our study failed to demonstrate that intracoronary administration of ADO prior to PCI limits infarct size, in patients receiving early PCI ADO might enhance myocardial salvage and has a favorable effect on LVEF evolution, which may help to reconcile apparently contradictory results of previous studies.
Clinical Trial Registration:
http://clinicaltrials.gov (NCT00781404).
