Department of Cardiovascular Medicine, University Hospitals Leuven, Gasthuisberg, Herestraat 49, Leuven, Belgium.
Eur Heart J. 2011 Apr;32(7):867-77. doi: 10.1093/eurheartj/ehq492. Epub 2010 Dec 31.
Previous studies have suggested that intravenous administration of adenosine improves myocardial reperfusion and reduces infarct size in ST-elevation myocardial infarction (STEMI) patients. Intracoronary administration of adenosine has shown conflicting results.
In a prospective, single-centre, double-blind, placebo-controlled clinical study, we assessed whether selective intracoronary administration of adenosine distal to the occlusion site immediately before initial balloon inflation results in myocardial salvage and decreased microvascular obstruction (MVO) as assessed with cardiac magnetic resonance imaging (MRI). Using a combination of T(2)-weighted and contrast-enhanced sequences, myocardial salvage index (MSI) was defined as the percentage of the area at risk that did not become necrotic. We randomized 112 patients presenting with STEMI within 12 h from symptom onset to selective intracoronary administration of adenosine 4 mg or matching placebo. In 100/110 (91%) patients receiving study drug, MRI was performed on Days 2-3. No significant difference in MSI was found between adenosine- and placebo-treated patients: 41.3% (20.8, 66.7) vs. 47.8% (39.8, 60.9) [median (Q1, Q3)] (P = 0.52). The extent of MVO was comparable in both groups, with a trend favouring the placebo group: 2.4 g (0.0, 6.8) vs. 5.9 g (0.0, 12.8) after adenosine (P = 0.07). TIMI flow grade, TIMI frame count, myocardial blush grade, and ST-segment resolution after primary percutaneous coronary intervention were similar between groups. After 4 months, infarct size was similar in both treatment groups.
We found no evidence that selective high-dose intracoronary administration of adenosine distal to the occlusion site of the culprit lesion in STEMI patients results in incremental myocardial salvage or a decrease in microvascular obstruction.
先前的研究表明，静脉内给予腺苷可改善 ST 段抬高型心肌梗死（STEMI）患者的心肌再灌注并减少梗死面积。冠状动脉内给予腺苷的结果则存在争议。
在一项前瞻性、单中心、双盲、安慰剂对照的临床研究中，我们评估了在初次球囊扩张前即刻于闭塞部位远端选择性冠状动脉内给予腺苷是否会导致心肌挽救和减少磁共振成像（MRI）评估的微血管阻塞（MVO）。使用 T2 加权和对比增强序列的组合，心肌挽救指数（MSI）定义为无坏死风险区域的百分比。我们将 112 例 STEMI 患者随机分为腺苷 4mg 或匹配安慰剂的选择性冠状动脉内给药组。在 110 例（91%）接受研究药物的患者中，在第 2-3 天行 MRI。腺苷组和安慰剂组的 MSI 无显著差异：41.3%（20.8，66.7）与 47.8%（39.8，60.9）[中位数（Q1，Q3）]（P=0.52）。两组的 MVO 程度相似，且安慰剂组有趋势更好：腺苷组为 2.4g（0.0，6.8）与安慰剂组的 5.9g（0.0，12.8）（P=0.07）。两组的 TIMI 血流分级、TIMI 帧数、心肌染色分级和直接经皮冠状动脉介入治疗后的 ST 段回落相似。4 个月后，两组的梗死面积相似。
我们没有发现证据表明在 STEMI 患者的罪犯病变闭塞部位远端选择性给予大剂量冠状动脉内腺苷可增加心肌挽救或减少微血管阻塞。
