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Safety and efficacy of intracoronary adenosine administration in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials.

AbstractBACKGROUND:
Studies evaluating intracoronary administration of adenosine for prevention of microvascular dysfunction and ischemic-reperfusion injury in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) have yielded mixed results. Therefore, we performed a meta-analysis of these trials to evaluate the safety and efficacy of intracoronary adenosine administration in patients with AMI undergoing primary PCI.
METHODS:
A total of seven prospective randomized controlled trials were analyzed. The endpoints extracted were post-procedure residual stent thrombosis (ST) segment elevation and ST segment resolutions (STRes), difference in peak creatine kinase (CK-MB) concentration, thrombolysis in myocardial infarction (TIMI) grade III flow (TIMI 3 flow), myocardial blush grade (MBG) 3, mean difference in post-PCI ejection fraction (EF), all-cause mortality, cardiovascular mortality, heart failure (HF) and major adverse cardiovascular event (MACE). Safety endpoints analyzed were bradycardia, second-degree atrioventricular block (AVB), ventricular tachycardia (VT), ventricular fibrillation (VF) and recurrence of chest pain (CP). The endpoints were analyzed by standard methods of meta-analysis.
RESULTS:
Intracoronary adenosine therapy led to significantly more post-PCI STRes [relative risk (RR) 1.39, 95% confidence interval (CI) 1.01-1.90; p = 0.04] and reduction in residual ST segment elevation (RR 0.82, CI 0.69-0.99; p = 0.04) but did not improve TIMI 3 flow (RR 1.09, CI 0.94-1.27; p = 0.25), MBG3 (RR 1.04, CI 0.65-1.69; p = 0.88), peak CK-MB concentration (mean difference -39.43, CI -120.223 to 41.371; p = 0.339) and post-PCI EF (mean difference 1.238, CI -5.802 to 8.277; p = 0.730). There was a trend towards improvement and MACE (RR 0.64, CI 0.40-1.03; p = 0.06), incidence of HF (RR 0.47, CI 0.19-1.12; p = 0.08) and CV mortality (RR 0.15, CI 0.02-1.23; p = 0.08) that did not reach statistical significance but no difference in all-cause mortality (RR 0.77, CI 0.25-2.34; p = 0.64). Safety analysis showed no significant difference in CP events (RR 1.26, CI 0.55-2.86; p = 0.58), bradycardia (RR 2.19, CI 0.24-0.38; p = 0.49), VT (odds ratio 0.61, CI 0.08-4.90; p = 0.64) and VF (RR 0.49, CI 0.13-1.90; p = 0.30), but significantly more second-degree AVB (RR 7.88, CI 4.15-14.9; p < 0.01) in the adenosine group compared with the placebo group.
CONCLUSION:
Intracoronary adenosine administration was well tolerated and significantly improved electrocardiographic outcomes with a tendency towards improvement in MACE, HF and CV mortality that could not reach statistical significance.
AuthorsMukesh Singh, Tejaskumar Shah, Kavia Khosla, Param Singh, Janos Molnar, Sandeep Khosla, Rohit Arora
JournalTherapeutic advances in cardiovascular disease (Ther Adv Cardiovasc Dis) Vol. 6 Issue 3 Pg. 101-14 (Jun 2012) ISSN: 1753-9455 [Electronic] England
PMID22562999 (Publication Type: Journal Article, Meta-Analysis, Review)
Chemical References
  • Vasodilator Agents
  • Creatine Kinase, MB Form
  • Adenosine
Topics
  • Adenosine (administration & dosage)
  • Angioplasty, Balloon, Coronary
  • Coronary Angiography
  • Coronary Circulation
  • Coronary Thrombosis (epidemiology)
  • Creatine Kinase, MB Form (analysis)
  • Electrocardiography
  • Heart Failure (epidemiology)
  • Humans
  • Myocardial Infarction (mortality, therapy)
  • Myocardial Reperfusion Injury (prevention & control)
  • Randomized Controlled Trials as Topic
  • Stents
  • Stroke Volume
  • Vasodilator Agents (administration & dosage)

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