Beneficial Effects of Intracoronary Adenosine as an Adjunct to Primary Angioplasty in Acute Myocardial Infarction

Abstract

Background —The benefits of vessel recanalization in acute myocardial infarction (AMI) are limited by reperfusion damage. In animal models, adenosine limits reperfusion injury, reducing infarct size and improving ventricular function. The aim of this study was to evaluate the safety and feasibility of adenosine adjunct to primary PTCA in AMI. Methods and Results —Fifty-four AMI patients undergoing primary PTCA were randomized to intracoronary adenosine or saline. The 2 groups were similar for age, sex, and infarct location. Adenosine administration was feasible and well tolerated. PTCA was successful in all patients and resulted in TIMI 3 flow in all patients given adenosine and in 19 given saline ( P <0.05). The no-reflow phenomenon occurred in 1 adenosine patient and in 7 saline patients ( P =0.02). Creatine kinase was lower in the adenosine group, and a Q-wave MI developed in 16 adenosine patients and in 23 saline patients ( P =0.04). Sixty-four percent of dyssynergic segments improved in the adenosine group and 36% in the saline group ( P =0.001). Function worsened in 2% of dyssynergic segments in the adenosine group and in 20% in the saline group ( P =0.0001). Adverse cardiac events occurred in 5 patients in the adenosine group and in 13 patients in the saline group ( P =0.03). Conclusions —Intracoronary adenosine administration is feasible and well tolerated in AMI. Adenosine adjunct to primary PTCA ameliorates flow, prevents the no-reflow phenomenon, improves ventricular function, and is associated with a more favorable clinical course.

Annexin A5 Scintigraphy of Forearm as a Novel In Vivo Model of Skeletal Muscle Preconditioning in Humans

“…The observed action of ischemic and pharmacological preconditioning on Annexin A5 targeting after ischemic exercise closely resembles the effect of these interventions on infarct size as demonstrated in various animals and organs, including skeletal muscle, 9,10,25 and a clinical trial in the heart. 26 This further indicates that this technique detects relevant early signs of ischemic exercise and reperfusioninduced injury and can be used for future pharmacological research to evaluate agents intended to protect against ischemia-reperfusion injury in humans in vivo. In this individual, percentage difference in radioactivity (counts per pixel) between experimental and control sides was 37% and 10% for thenar and flexor muscle, respectively.…”

Restoration of Normal Coronary Flow With Tirofiban by Intracoronary Administration for No-reflow Phenomenon After Stent Deployment

“…Intracoronary administration of verapamil 1) or adenosine 4) has been reported to be helpful in this situation. However, neither was shown to promptly and effectively restore the coronary flow.…”

Pathophysiological aspects and management workflow of coronary microvascular obstruction in ST-segment elevation myocardial infarction

“…Indeed, if IV adenosine started before reperfusion might improve the outcome when given early (<3.2 h from chest pain onset) as compared to placebo, 55 other reports have provided mixed results regarding the role of IC adenosine. 56,57 In the REOPEN-AMI trial, we found high dosages of IC adenosine, given after thrombus aspiration through the aspiration catheter, improved STR and enzymatic IS as compared to placebo or sodium nitroprusside, which translated in a reduction of major adverse cardiac events (MACEs) and a better left ventricular remodelling at 1-year follow-up. 58,59 Moreover, atrial natriuretic peptide (ANP), cyclosporine and exenatide, known to have cardioprotective effects, have shown beneficial effects on IS while the effect on indexes of CMVO is neutral or not reported.…”