Beneficial effect of adenosine on myocardial perfusion in patients treated with primary percutaneous coronary intervention for acute myocardial infarction

Abstract

The present study investigated the effects of intravenous adenosine on myocardial perfusion and segmental contractile function when used as an adjunct of primary percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI). &#129;Patients were randomly assigned to receive intravenous adenosine (n = 35) or saline (n = 34) within 12 h of STEMI. Myocardial contrast echocardiography (MCE) and velocity vector imaging (VVI) were performed 7 days after primary PCI. Serial echocardiography was performed on Days 7 and 30. Capillary blood volume (A; 6.34 ± 1.98 vs 5.64 ± 1.84 dB; P = 0.03) and myocardial blood velocity (β; 0.13 ± 0.04 vs 0.1 ± 0.04/s; P = 0.01) were higher in the adenosine group than in control patients. Myocardial blood flow (A × β) was 0.82 ± 0.37 dB/s with adenosine compared with 0.57 ± 0.4 dB/s in control patients (P < 0.01). Improvements were seen in the adenosine compared with the control group in terms of myocardial wall strain(-13.52 ± 5.61% vs -11.47 ± 5.25%, respectively; P = 0.03), strain rate (-1.08 ± 0.52 vs -0.90 ± 0.44/s, respectively; P = 0.03) and segmental ejection fraction (53.66 ± 12.04% vs 48.40 ± 14.99%, respectively; P = 0.03). There was a correlation between myocardial perfusion in apical anterior segments, peak systolic strain (P = 0.001), strain rate (P = 0.001) and segmental ejection (P < 0.001). Global contractile function was better in the adenosine-treated than control group. At the 1 month follow up, there were no significant differences between groups in terms of the incidence of recurrent angina or heart failure. The results of the present study suggest that periprocedural intravenous adenosine contributes to improvements in myocardial perfusion, segmental wall motion and global contractile function in patients with acute myocardial infarction undergoing primary PCI.

Cardiac purinergic signalling in health and disease

“…In a clinical trial, a high dose of intracoronary adenosine given during percutaneous coronary intervention (PCI) did not reduce infarct size [638]. However, a later study provided evidence for contrasting beneficial effects of adenosine under similar conditions [639]. Intracoronary administration of adenosine, but not of nitroprusside, resulted in a significant improvement following acute MI [640].…”

Functional adaptations of the coronary microcirculation to anaemia in fetal sheep

“…In this study we found that the elevated cardiac microvascular flow in anaemic fetuses was achieved by faster average microvascular blood flux rate, but that MBV fraction at rest was not altered by chronic fetal anaemia. This finding is unexpected as MBV typically increases when growth or remodelling increases coronary flow in adults (Di Bello et al 2003;Indermuhle et al 2006;Ikonomidis et al 2010;Santos et al 2010;Wang et al 2012). Fetal capillary widening in concert with decreased haematocrit can explain the increased coronary microvascular flow observed by MCE.…”

Effect of New Method of Intracoronary Adenosine Injection during Primary Percutaneous Coronary Intervention on Microvascular Reperfusion Injury - Clinical Outcome and 1-Year Follow-Up

“…Also, Sakuma et al [31] in a group of patients with first anterior myocardial infarction, after intravenous administration of a high dose of adenosine (150 ug/kg/min started 5 min before the beginning of the primary PCI and continued for up to 1 h) observed enhanced ST segment resolution 90 min after recanalization, reduced no-reflow ratio, preserved left ventricular systolic function and prevented left ventricular remodeling at 6 months after primary PCI. Wang et al [32], after intravenous adenosine infusion (50 μg/kg/min for 3 h) in patients with acute ST segment elevation noted improved myocardial perfusion, segmental wall motion and global contractile function.…”