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Updated: Oct 31, 2025

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

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Adenosine-Induced Coronary Steal Is Observed in Patients Presenting With ST-Segment-Elevation Myocardial Infarction

Muhammad Aetesam-Ur-Rahman1,2, Adam J Brown3, Catherine Jaworski4

  • 1Department of Interventional Cardiology Royal Papworth Hospital Cambridge United Kingdom.

Journal of the American Heart Association
|June 30, 2021
PubMed

Insights

Adenosine can cause coronary steal, reducing blood flow reserve in ST-segment-elevation myocardial infarction patients. This phenomenon is linked to better collateral circulation and higher microvascular resistance, impacting treatment effectiveness.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Physiology

Background:

  • Adenosine is used to manage no-reflow during ST-segment-elevation myocardial infarction (STEMI) interventions.
  • Its physiological effects in the infarct-related artery (IRA) are variable, with coronary steal (reduced distal flow) a known complication facilitated by collaterals.
  • Understanding adenosine's impact on coronary flow reserve (CFR) in STEMI is crucial for optimizing treatment.

Purpose of the Study:

  • To investigate the effects of adenosine on coronary flow reserve (CFR) in patients with ST-segment-elevation myocardial infarction (STEMI).
  • To elucidate the physiological mechanisms underlying the variable response to adenosine, specifically the occurrence of coronary steal.
  • To correlate coronary steal with microvascular resistance and collateral function in STEMI patients.

Main Methods:

  • Pressure-wire assessment of the infarct-related artery (IRA) in 93 STEMI patients post-percutaneous coronary intervention.
  • Calculation of index of microvascular resistance (IMR), CFR, and collateral flow index (CFI) by pressure.
  • Assessment of collateral status using modified Rentrop grade and microvascular obstruction via cardiac MRI.

Main Results:

  • Adenosine-induced coronary steal (CFR <0.9) occurred in 20% of patients.
  • Coronary steal was associated with higher modified Rentrop scores (p<0.001) and CFI (p=0.004).
  • Patients experiencing steal had increased IMR (p=0.006) and more donor artery disease (p=0.02) compared to the hyperemic group.

Conclusions:

  • Adenosine-induced coronary steal can reduce coronary flow reserve in a significant proportion of STEMI patients.
  • Collateral function and microvascular resistance play key roles in mediating adenosine's effect on CFR.
  • These findings highlight the complex interplay of factors influencing adenosine's efficacy in STEMI interventions.

Keywords:
ST‐segment–elevation myocardial infarctionadenosinecollateral circulationmicrovascular dysfunction

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