Outcomes of High-Dose Intracoronary Adenosine Protocol in Saphenous Venous Graft Percutaneous Coronary Intervention:...

Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) carries a high-risk of slow or no-reflow (SNR)-up to 15% in stable ischemia and 29% in acute coronary syndrome (ACS)-leading to higher major adverse cardiovascular event rates. Evidence on high-dose intracoronary adenosine for SNR prevention remains limited.

We analyzed 171 patients with stable ischemic heart disease or ACS who underwent SVG PCI without embolic protection devices from 2010 to 2024 at our center. All received 200 to 400 μg intracoronary adenosine within 30 seconds just prior to each balloon or stent inflation, and post-PCI outcomes were evaluated.

Of 171 patients, 71.2% were mene, and 83% presented with ACS. Pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow was <3 in 41.1% of the patients. Using the adenosine protocol, no-reflow occurred in 1.2% and slow flow in 4.7%. SNR incidence was 0% in patients with pre-PCI TIMI flow 3 vs higher in those with pre-PCI TIMI <3 (P = .01). Major adverse cardiovascular event rates were 2.3%, 4.6%, and 8.7% at in-hospital, 30-day, and 1-year follow-up, respectively, with significantly better outcomes in the TIMI 3 group (P = .020). Target vessel revascularization was 3.5% at both 30 days and 1 year.

High-dose intracoronary adenosine protocol described in this study markedly reduced the incidence of SNR and was associated with improved short- and long-term outcomes in patients undergoing SVG PCI.