Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial.

Abstract

OBJECTIVES:

The Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial was designed to test the hypothesis that adenosine as an adjunct to thrombolysis would reduce myocardial infarct size.

BACKGROUND:

Reperfusion therapy for acute myocardial infarction (MI) has been shown to reduce mortality, but reperfusion itself also may have deleterious effects.

METHODS:

The AMISTAD trial was a prospective, open-label trial of thrombolysis with randomization to adenosine or placebo in 236 patients within 6 h of infarction onset. The primary end point was infarct size as determined by Tc-99 m sestamibi single-photon emission computed tomography (SPECT) imaging 6+/-1 days after enrollment based on multivariable regression modeling to adjust for covariates. Secondary end points were myocardial salvage index and a composite of in-hospital clinical outcomes (death, reinfarction, shock, congestive heart failure or stroke).

RESULTS:

In all, 236 patients were enrolled. Final infarct size was assessed in 197 (83%) patients. There was a 33% relative reduction in infarct size (p = 0.03) with adenosine. There was a 67% relative reduction in infarct size in patients with anterior infarction (15% in the adenosine group vs. 45.5% in the placebo group) but no reduction in patients with infarcts located elsewhere (11.5% for both groups). Patients randomized to adenosine tended to reach the composite clinical end point more often than those assigned to placebo (22% vs. 16%; odds ratio, 1.43; 95% confidence interval, 0.71 to 2.89).

CONCLUSIONS:

Many agents thought to attenuate reperfusion injury have been unsuccessful in clinical investigation. In this study, adenosine resulted in a significant reduction in infarct size. These data support the need for a large clinical outcome trial.

• Authors: K W Mahaffey, J A Puma, N A Barbagelata, M F DiCarli, M A Leesar, K F Browne, P R Eisenberg, R Bolli, A C Casas, V Molina-Viamonte, C Orlandi, R Blevins, R J Gibbons, R M Califf, C B Granger
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 34 Issue 6 Pg. 1711-20 (Nov 15 1999) ISSN: 0735-1097 [Print] United States
• PMID: 10577561 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Vasodilator Agents
• Adenosine

Topics

• Adenosine (therapeutic use)
• Adult
• Aged
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnostic imaging, drug therapy)
• Prospective Studies
• Radiography
• Thrombolytic Therapy
• Tomography, Emission-Computed, Single-Photon
• Treatment Outcome
• Vasodilator Agents (therapeutic use)