Efficacy of Adenosine in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

Whether adenosine offers cardioprotective effects when used as an adjunctive therapy for patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) remains controversial.To evaluate, via meta-analysis, the efficacy of adenosine in patients with AMI undergoing PCI.Randomized controlled trials (RCTs) published in Medline, Embase, and the Cochrane Central Register of Controlled Trials.RCTs of patients with AMI undergoing primary PCI, comparing adenosine treatment and placebo groups and reporting mortality, thrombolysis in myocardial infarction (TIMI) flow grade, myocardial blush grade (MBG), re-infarction, left-ventricular ejection fraction (LVEF), ST-segment elevation resolution (STR), recurrent angina, or heart failure (HF).Risk of bias was assessed by the Cochrane guidelines and publication bias by Egger's test. For studies reported in multiple publications, the most complete publication was used. Arms using different dosing schedules were merged. Mean differences (MDs) or risk ratios (RRs) were determined.Data were extracted from 15 RCTs involving 1736 patients. Compared with placebo, adenosine therapy was associated with fewer occurrences of heart failure (RR: 0.65, 95% confidence interval [CI]: 0.43-0.97, P=0.03) and no-reflow (TIMI flow grade <3, RR: 0.62, 95% CI: 0.45-0.85, P=0.003; MBG=0-1, RR: 0.81; 95% CI: 0.67-0.98, P=0.03), more occurrences of STR (RR: 1.19, 95% CI: 1.07-1.31, P<0.00001), but no overall improvement of LVEF (MD: 2.29, 95% CI: −0.09 to 4.67, P=0.06). Adenosine improved LVEF in the intravenous subgroup and the regular-dose intracoronary (IC) subgroup (0.24-2.25mg) compared with placebo (MD: 2.68, 95% CI: 0.66-4.70, P=0.009). Adenosine was associated with a poorer LVEF in the high-dose (4-6mg) IC subgroup (MD: −2.40; 95% CI: −4.72 to −0.09, P=0.04). There was no significant evidence that adenosine reduced rates of all-cause mortality, cardiovascular mortality or re-infarction after PCI.Adenosine dosage and administration routes, baseline profiles, and endpoints differed among included RCTs. Performance, publication, and reporting biases remain possible.Adenosine therapy appears to improve several outcomes in patients with AMI after PCI, but there is no evidence that adenosine can reduce mortality rates.

Cardiovascular events associated with nicorandil administration prior to primary percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction: a systematic review and meta-analysis

“…These combined effects are expected to help promote myocardial recovery. Other possible approaches that have been evaluated to reduce reperfusion injury following PCI in patients with STEMI have included ischemic conditioning [48,49] and adenosine [50,51]: the results of these studies varied in terms of myocardial protection and survival benefits.…”

Fenómeno de no reflujo en la angioplastia coronaria: incidencia, características clínico-angiográficas y eficacia del tratamiento

“…Tres metaanálisis recientes permiten concluir que la adenosina intracoronaria utilizada en pacientes con SCAcST tratados con ATC primaria se asocia con menor incidencia de flujo TIMI <3 y mayor frecuencia de renivelación del segmento ST (28)(29)(30) . El metaanálisis de red de Niu y colaboradores evaluó el efecto de siete agentes farmacológicos de uso intracoronario (adenosina, anisodamina, diltiazem, nicorandil, nitroprusiato, urapidil y verapamil) sobre el NR en pacientes con SCAcST tratados con ATC primaria.…”

Adenosine receptors as therapeutic targets for the treatment of myocardial infarction and its complications. Part I. Myocardial infarction

“…No -reflow is a complication of PCI, where the flow in a coronary vessel stops despite effective revascularization. Myocardial infarction complicated by no -reflow is difficult to treat and is associated with a worse prognosis for the patient [63]. In their papers, these authors stressed that the shortest possible time before restoration of coronary artery patency was the factor that determined whether the aforementioned benefits were achieved or not.…”

“…The results of 3 meta -analyses published in 2015-2016 [55,63,71] agreed that adenosine improved myocardial perfusion and prevented no -reflow, although Bulluck et al [71] indicated that this effect was observed following intracoronary administration rather than intravenous infusion. Moreover, adenosine decreased the prevalence of heart failure and improved LVEF [63]. Nevertheless, no clinical benefits were observed, such as a reduced risk of death [55,63] or subsequent infarction [63].…”

“…Moreover, adenosine decreased the prevalence of heart failure and improved LVEF [63]. Nevertheless, no clinical benefits were observed, such as a reduced risk of death [55,63] or subsequent infarction [63]. Administration of adenosine is associated with the occurrence of short -term adverse events, such as bradycardia, hypotension and atrioventricular block [55].…”