Impact of time to therapy and reperfusion modality on the efficacy of adenosine in acute myocardial infarction: the AMISTAD-2 trial

Kloner, Robert A.; Forman, Mervyn B.; Gibbons, Raymond J.; Ross, Allan M.; Alexander, R. Wayne; Stone, Gregg W.

doi:10.1093/eurheartj/ehl094

Cited by 220 publications

(152 citation statements)

References 22 publications

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“…Differences in way of administration, timing and dosages may explain the discrepancies observed in the studies. 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.…”

Section: Before Catheterization Laboratorymentioning

confidence: 99%

“…Furthermore, some drug infusion started in the catheterization laboratory may be continued in CCU. In particular, beneficial effects have been shown for IV IIb-IIIa inhibitors, 76 adenosine, 55 ANP 60 and more recently exenatide. 62 The duration of IV infusion for such therapies in CCU should be matter of future studies, as currently tested drugs have been administered for variable times from 3 h to 12 h. More prolonged therapies (up to 24 h) may possibly increase the rate of reversible CMVO, that has been described to occur spontaneously in nearly half of patients after 1 month.…”

Section: After Catheterization Laboratorymentioning

confidence: 99%

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

2016

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Restoring blood flow to ischemic but viable myocardium and reducing infarct size constitute the goals of reperfusion therapy with fibrinolytic drugs or primary percutaneous intervention in patients with ST-segment elevation myocardial infarction (STEMI). However, in a sizable proportion of patients, this intervention gains to reopen the obstructed epicardial coronary artery but does not achieve myocardial reperfusion because of coronary microvascular obstruction phenomenon (CMVO). In the last years, consistent evidence has pointed out how CMVO has a negative impact on outcome in patients with acute STEMI. Of note, most of the trials in this setting, mainly targeting reperfusion damage, have failed to show beneficial effects. In this article we provide a revision of mechanisms, diagnosis and prognosis of CMVO in acute STEMI, also pointing out the need of an integrated approach in order to prevent and treat CMVO in the different time windows of the acute event.

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Section: Before Catheterization Laboratorymentioning

confidence: 99%

Section: After Catheterization Laboratorymentioning

confidence: 99%

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

2016

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“…The early intravenous administration of betablockers has recently fallen out of favor due to unfavorable results of the COMMIT-CCS2 trial-however; poor patient selection may have been contributory [12,13].…”

Section: Pharmacotherapy For Cardioprotectionmentioning

confidence: 99%

Myocardial Infarction and Protection

Chatterjee¹

2012

J Clin Exp Cardiolog

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“…2 A post hoc analysis of AMISTAD II demonstrates significant reduction in both 1-and 6-month mortality in patients treated with adenosine within 3.17 h of symptoms. 9 Moreover, intracoronary adenosine administered prior to PTCA improves TIMI flow, and prophylactic intracoronary adenosine reduces "no-reflow" in STEMI patients undergoing stent implantation. 2 There are also isolated reports of adenosine to treat embolic "no-reflow" after PCI of saphenous vein grafts.…”

Section: Adenosinementioning

confidence: 99%

Importance of Tissue Perfusion in ST Segment Elevation Myocardial Infarction Patients Undergoing Reperfusion Strategies: Role of Adenosine

Forman

Jackson

2007

Clinical Cardiology

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SummaryHigh risk ST segment elevation myocardial infarction (STEMI) patients undergoing reperfusion therapy continue to exhibit significant morbidity and mortality due in part to myocardial reperfusion injury. Importantly, preclinical studies demonstrate that progressive microcirculatory failure (the "no-reflow" phenomenon) contributes significantly to myocardial reperfusion injury. Diagnostic techniques to measure tissue perfusion have validated this concept in humans, and it is now clear that abnormal tissue perfusion occurs frequently in STEMI patients undergoing reperfusion therapy. Moreover, because tissue perfusion correlates poorly with epicardial blood flow (TIMI flow grade), clinical studies show that tissue perfusion is an independent predictor of early and late mortality in STEMI patients and is associated with infarct size, ventricular function, CHF and ventricular arrhythmias. The mechanisms responsible for abnormal tissue perfusion are multifactorial and include both mechanical obstruction and vasoconstrictor humoral factors. Adenosine, an endogenous nucleoside, maintains microcirculatory flow following reperfusion by activating four well-characterized extracellular receptors. Because activation of adenosine receptors attenuates the mechanical and functional mechanisms leading to the "no reflow" phenomenon and activates other cardioprotective pathways as well, it is not surprising that both experimental and clinical studies show striking myocardial salvage with intravenous infusions of adenosine administered in the peri-reperfusion period. For example, a post hoc analysis of the AMISTAD II trial indicates a significant reduction in 1 and 6-month mortality in STEMI patients undergoing reperfusion therapy who are treated with adenosine within 3 hours of symptoms. In conclusion, adenosine's numerous cardioprotective effects, including attenuation of the "no-reflow" phenomenon, support its use in high risk STEMI undergoing reperfusion.

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Impact of time to therapy and reperfusion modality on the efficacy of adenosine in acute myocardial infarction: the AMISTAD-2 trial

Abstract: In this post hoc analysis, 3 h adenosine infusion administered as an adjunct to reperfusion therapy within the first 3.17 h onset of evolving anterior ST-segment elevation AMI enhanced early and late survival, and reduced the composite clinical endpoint of death or CHF at 6 months.

Cited by 220 publications

References 22 publications

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

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

Myocardial Infarction and Protection

Importance of Tissue Perfusion in ST Segment Elevation Myocardial Infarction Patients Undergoing Reperfusion Strategies: Role of Adenosine

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