Navarese EP et al. – This meta–analysis shows that adenosine adjunctive therapy does not improve survival nor reduce the rates of re–MI and heart failure (HF) symptoms in patients with acute coronary syndromes (ACS) treated with PCI or thrombolysis. The beneficial effect on post–procedural coronary flow was not associated with consistent advantages on clinical outcomes.

• Medline/CENTRAL/EMBASE and Google Scholar database were scanned.
• The meta–analysis included ten RCTs (N=3821).
• All–cause mortality was chosen as primary endpoint.
• Secondary endpoints were re–infarction (MI), heart failure (HF) symptoms (NYHA class III/IV), no–reflow (defined as TIMI 0 flow) and >50% ST–resolution.

• Adenosine compared to placebo was associated with a significant reduction of post–procedural no–reflow (OR [95% CI]=0.25 [0.08–0.73], p=0.01); however, at a median follow–up of 6 months, prior treatment with adenosine did not confer significant benefits in terms of reduction of mortality (ORFixed [95% CI]=0.87 [0.69–1.09], p=0.23), as well as re–MI (p=0.80), HF symptoms (p=0.44) and ST–resolution (p=0.09).
• Separate analyses conducted in the subgroups of ST–elevation MI patients treated with either PCI or thrombolysis confirmed the findings found in the overall population.