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Three hours continuous injection of adenosine improved left ventricular function and infarct size in patients with ST-segment elevation myocardial infarction Full Text
Chinese Medical Journal, 06/01/2012
Clinical Article
Hang Z et al. – Intravenous adenosine administration might significantly reduce the recurrence of no–reflow, with resultant improved left ventricular systolic function. High–dose adenosine was further associated with significant reduction of infarct size.
Methods- Patients with STEMI within 12 hours from the onset of symptoms were randomized by 1:1:1 ratio to receive either adenosine 50 µg.kg–1.min–1 (low–dose group, n=31), or 70 µg.kg–1.min–1 (high–dose group, n=32), or saline 1 ml/min (control group, n=27) for three hours.
- Drugs were given to the patients immediately after the guide wire crossed the culprit lesion.
- Recurrence of no–reflow, TIMI flow grade (TFG) and TIMI myocardial perfusion grade (TMPG), and collateral circulation were recorded.
- The postoperative and preoperative ST segment elevation sum of 18–lead electrocardiogram (ECG) and their ratio (STsum–post/STsum–pre) were recorded, as well as the peak time and peak value of CK–MB enzyme.
- Serial cardiac echo and myocardial perfusion imaging were performed at 24 hours and 6 months post–stenting.
- The primary endpoint was left ventricular function, and infarct size.
- The secondary end–point was the occurrence of cardiac and non–cardiac death, non–fatal myocardial infarction, and heart failure.
- A total of 90 STEMI patients were studied.
- No–reflow immediately after stent procedure was seen in 11 (35.5%) patients in the control group, significantly different from 6.3% in the low–dose group or 3.7% in the high–dose group (both P=0.001).
- STsum–post/STsum–pre in the low–dose and high–dose groups was significantly different from the control group (low–dose group vs. control group, P=0.003 and high–dose group vs. control group, P=0.001), without a dose–dependent pattern (P=0.238).
- The peak value of CK–MB enzyme was significantly reduced in the high–dose group compared to the control group (P=0.024).
- Compared to the left ventricular ejection fraction (LVEF) in control group, LVEF in the low–dose group increased by 5.8% at 24 hours (P=0.012) and by 10.9% at 6 months (P=0.007), LVEF in the high–dose group increased by 9.5% at 24 hours (P=0.001) and by 10.0% at 6 months (P=0.001), respectively.
- Significant reduction of infarct size by 24.2% was detected in the high–dose group vs. low–dose or control groups (P=0.008).
- There was no significant difference regarding secondary endpoints at 6 months among the treated groups.
- Cardiac function by NYHA classification in both the low–dose and the high–dose groups was improved significantly (P=0.013, P=0.016).