TY - JOUR
T1 - Improvement in microvascular reflow and reduction of infarct size with Adenosine in patients undergoing primary coronary stenting
AU - Micari, Antonio
AU - Belcik, Todd A.
AU - Balcells, Eduardo A.
AU - Powers, Eric
AU - Wei, Kevin
AU - Kaul, Sanjiv
AU - Lindner, Jonathan R.
N1 - Funding Information:
This study was supported by Grants R01-DK-063508, R01-HL-074443, and R01-HL-65704 from the National Institutes of Health, Bethesda, Maryland; and a Grant-in-Aid from the American Heart Association, Mid-Atlantic Affiliate, Baltimore, Maryland.
PY - 2005/11/15
Y1 - 2005/11/15
N2 - The aim of this study was to use myocardial contrast echocardiography to evaluate the effect of intravenous adenosine on microvascular reflow in patients with acute myocardial infarction who underwent primary coronary stenting (PCS). Thirty patients who underwent primary PCS for acute myocardial infarction were randomized to intravenous adenosine (50 to 70 μg/kg/min) or vehicle for 3 hours. Myocardial contrast echocardiography was performed before and sequentially after PCS to determine the risk area during coronary occlusion and infarct size. The risk area was similar in the adenosine- and placebo-treated patients. The infarct size as a ratio to the risk area was smaller in patients treated with adenosine when measured at 3 to 5 days (0.37 ± 0.29 vs 0.68 ± 0.25, p <0.01) and at 4 weeks (0.34 ± 0.26 vs 0.60 ± 0.21, p <0.01) after PCS. This effect was greatest when patency was achieved <4 hours after symptom onset (0.18 ± 0.18 vs 0.74 ± 0.31, p <0.05), with little effect after 4 hours. The relative microvascular blood volume in the risk area at 4 weeks was higher in patients receiving adenosine than in those receiving placebo (0.73 ± 0.22 vs 0.57 ± 0.20, p <0.01), and was highest when patency was achieved in <4 hours. In conclusion, the adjunctive use of intravenous adenosine after PCS reduces the infarct size relative to the risk area. This beneficial effect occurs primarily in those undergoing early intervention.
AB - The aim of this study was to use myocardial contrast echocardiography to evaluate the effect of intravenous adenosine on microvascular reflow in patients with acute myocardial infarction who underwent primary coronary stenting (PCS). Thirty patients who underwent primary PCS for acute myocardial infarction were randomized to intravenous adenosine (50 to 70 μg/kg/min) or vehicle for 3 hours. Myocardial contrast echocardiography was performed before and sequentially after PCS to determine the risk area during coronary occlusion and infarct size. The risk area was similar in the adenosine- and placebo-treated patients. The infarct size as a ratio to the risk area was smaller in patients treated with adenosine when measured at 3 to 5 days (0.37 ± 0.29 vs 0.68 ± 0.25, p <0.01) and at 4 weeks (0.34 ± 0.26 vs 0.60 ± 0.21, p <0.01) after PCS. This effect was greatest when patency was achieved <4 hours after symptom onset (0.18 ± 0.18 vs 0.74 ± 0.31, p <0.05), with little effect after 4 hours. The relative microvascular blood volume in the risk area at 4 weeks was higher in patients receiving adenosine than in those receiving placebo (0.73 ± 0.22 vs 0.57 ± 0.20, p <0.01), and was highest when patency was achieved in <4 hours. In conclusion, the adjunctive use of intravenous adenosine after PCS reduces the infarct size relative to the risk area. This beneficial effect occurs primarily in those undergoing early intervention.
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U2 - 10.1016/j.amjcard.2005.06.090
DO - 10.1016/j.amjcard.2005.06.090
M3 - Article
C2 - 16275189
AN - SCOPUS:27644525710
SN - 0002-9149
VL - 96
SP - 1410
EP - 1415
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 10
ER -