Intracoronary injection of adenosine before reperfusion in patients with ST-segment elevation myocardial infarction: A randomized controlled clinical trial

Garcı́a-Dorado, David; Blanco, Bruno García del; Otaegui, Imanol; Rodríguez-Palomares, José F.; Pineda, Víctor; Gimeno, Federico; Ruíz-Salmerón, Rafael; Elı́zaga, Jaime; Evangelista, Arturo; Fernández‐Avilés, Francisco; Sanromán, A.L; Ferreira‐González, Ignacio

doi:10.1016/j.ijcard.2014.09.203

Cited by 65 publications

(38 citation statements)

References 31 publications

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“…106 Some studies have reported reductions in MI size with high-dose intravenous adenosine administered as a 3 h infusion initiated prior to reperfusion in STEMI patients presenting within 3 h of chest pain onset, 107–109 with other studies using lower doses of IV adenosine or boluses of intracoronary adenosine being less successful at reducing MI size. 110 A recent meta-analysis has shown a positive effect of adenosine treatment on heart failure outcomes in reperfused STEMI patients. 106 Therefore, larger clinical trials are needed to test whether this therapeutic approach is effective in STEMI patients presenting with shorter ischaemic times.…”

Section: Adenosinementioning

confidence: 99%

Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction: trials and tribulations

et al. 2016

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Section: Adenosinementioning

confidence: 99%

Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction: trials and tribulations

et al. 2016

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“…228 For intracoronary adenosine, concordantly reduced infarct size (creatine kinase and MRI) and less microvascular obstruction (TIMI flow on angiography) were reported in patients undergoing interventional reperfusion for acute myocardial infarction in 2 229,230 but not in 3 other studies. 31,231,232 Intravenous nitrite in patients with ST-segment elevation myocardial infarction and interventional reperfusion failed to reduce infarct size (biomarker and MRI) or to affect TIMI flow (angiography). 233 Intracoronary nitrite in patients with ST-segment elevation myocardial infarction and interventional reperfusion reduced infarct size (creatine kinase and MRI) only in a subgroup of patients with TIMI flow ≤1 at admission, and in this subgroup, intracoronary nitrite also reduced the area of microvascular obstruction (MRI).…”

Section: Clinical Studiesmentioning

confidence: 99%

The Coronary Circulation as a Target of Cardioprotection

Heusch

2016

Circulation Research

204

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Abstract:The atherosclerotic coronary vasculature is not only the culprit but also a victim of myocardial ischemia/ reperfusion injury. Manifestations of such injury are increased vascular permeability and edema, endothelial dysfunction and impaired vasomotion, microembolization of atherothrombotic debris, stasis with intravascular cell aggregates, and finally, in its most severe form, capillary destruction with hemorrhage. In animal experiments, local and remote ischemic pre-and postconditioning not only reduce infarct size but also these manifestations of coronary vascular injury, as do drugs which recruit signal transduction steps of conditioning. Clinically, no-reflow is frequently seen after interventional reperfusion, and it carries an adverse prognosis. The translation of cardioprotective interventions to clinical practice has been difficult to date. Only 4 drugs (brain natriuretic peptide, exenatide, metoprolol, and esmolol) stand unchallenged to date in reducing infarct size in patients with reperfused acute myocardial infarction; unfortunately, for these drugs, no information on their impact on the ischemic/reperfused coronary circulation is available. (Circ Res.

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“…Moreover, in some studies the effect was only observed on secondary endpoints or in post hoc analysis. The effect of adenosine was neutral in the overall population, but protective in the subgroup of patients with short duration of symptoms 25 30. Similar, the anti-inflammatory compound FX06 treatment did only reduce infarct size in patients with short duration of symptoms 26…”

Section: Protecting the Heart During Reperfusion By Primary Pcimentioning

confidence: 85%

“…It seems that longer time of ischaemia results in loss of cardioprotection,25 26 30 37 and therefore, focus on the early presenters in clinical trials is important. This may be because interventions generally are most effective in the first two to three hours after onset of ischaemia, patients with long duration of ischaemia demonstrate large areas of irreversible myocardial damage and subsequently fewer cardiomyocytes are exposed to reperfusion injury with a potential of reversibility, and longer duration of ischaemia leads to changes in the mitochondria, rendering them more resistant to cardioprotection.…”

Section: Determinants Of Reperfusion Injury In Patients With Stemimentioning

confidence: 99%

Targeting reperfusion injury in the era of primary percutaneous coronary intervention: hope or hype?

Lønborg

2015

Heart

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Introduction of reperfusion therapy by primary percutaneous coronary intervention (PCI) has resulted in improved outcomes for patients presenting with ST-segment elevation myocardial infarction. Despite the obvious advantages of primary PCI, acute restoration of blood flow paradoxically also jeopardises the myocardium in the first minutes of reperfusion-a phenomenon known as reperfusion injury. Prevention of reperfusion injury may help to improve outcome following primary PCI. This review focuses on the clinical evidence of potential therapeutic cardioprotective methods as adjuvant to primary PCI. Despite overall disappointing, there exists some promising strategies, including ischaemic postconditioning, remote ischaemic conditioning, pharmacological conditioning with focus on adenosine, cyclosporine A, glucose-insulin-potassium, exenatide, atrial natriuretic peptide and metoprolol and cooling. But hitherto no large randomised study has demonstrated any effect on outcome, and ongoing studies that address this issue are underway. Moreover, this review will discuss important clinical predictors associated with reperfusion injury during primary PCI that may interfere with a potential protective effect (pre-PCI thrombolysis in myocardial infarction flow, preinfarction angina, collateral flow, duration of ischaemia and hyperglycaemia). This paper will also provide a short overview of the technical issues related to surrogate endpoints in phase II trials. Based upon these discussions, the paper will provide factors that should be taken into account when designing future clinical studies.

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Intracoronary injection of adenosine before reperfusion in patients with ST-segment elevation myocardial infarction: A randomized controlled clinical trial

Cited by 65 publications

References 31 publications

Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction: trials and tribulations

Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction: trials and tribulations

The Coronary Circulation as a Target of Cardioprotection

Targeting reperfusion injury in the era of primary percutaneous coronary intervention: hope or hype?

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