Sanati Hamid Reza, Ghanavati Reza, Zahedmehr Ali, Shakerian Farshad, Bakhshandeh Hooman, Firouzi Ata, Kiani Reza
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Tehran Heart Cent. 2013 Jan;8(1):28-34. Epub 2013 Jan 8.
Significant elevation of cardiac biomarkers after percutaneous coronary intervention (PCI) is associated with increased mortality. However, clinical importance of lesser degrees of cardiac enzyme elevation has not been well understood. Multiple factors might have an etiologic role, and the incidence of myonecrosis has not changed dramatically despite pharmacological and technological advances in PCI. The aim of this study was to evaluate the role of intracoronary (IC) Adenosine in preventing the elevation of cardiac enzymes as a marker of myonecrosis after PCI in patients with chronic stable angina.
Two hundred sixty patients with chronic stable angina who were candidates for PCI were randomly assigned to double-blinded pretreatment with IC Adenosine or placebo before crossing of the guide wire. The patients were observed during the hospital course, and blood samples were obtained in standard intervals after the intervention for cardiac biomarkers. The primary end point of this study was post-PCI myonecrosis, and secondary end point was safety of IC Adenosine administration in the setting of PCI in patients with chronic stable angina.
Of the 260 patients, who were initially randomized, finally 83 patients were analyzed in the placebo and 96 in the Adenosine arms. The study patients were comparable in clinical and angiographic characteristics. The mean of the patients' age was 57.3 years (range = 35 to 79 years), and 71.5% were male. There were no differences in the mean serum cardiac biomarkers between the study groups (mean creatine kinase-MB [CK.MB] level of 29.5 ± 14.5 IU/L in the placebo group and 31.5 ± 18.5 IU/L in the control group; p value = 0.41; mean cardiac troponin I (cTnI) level of 0.097 ± 0.178 μg/L in the placebo group and 0.167 ± 0.5 μg/L in the control group; p value = 0.24).
Despite promising results in primary PCI, our study showed that a strategy of IC Adenosine pretreatment is not beneficial in reducing post-PCI myonecrosis in patients with chronic stable angina and should not be routinely used.
经皮冠状动脉介入治疗（PCI）后心脏生物标志物显著升高与死亡率增加相关。然而，心脏酶轻度升高的临床重要性尚未得到充分理解。多种因素可能具有病因学作用，尽管PCI在药理学和技术方面取得了进展，但心肌坏死的发生率并未显著改变。本研究的目的是评估冠状动脉内（IC）腺苷在预防慢性稳定型心绞痛患者PCI后作为心肌坏死标志物的心脏酶升高方面的作用。
260例适合PCI的慢性稳定型心绞痛患者在导丝穿过前被随机分配接受IC腺苷或安慰剂的双盲预处理。在住院期间观察患者，并在干预后按标准间隔采集血样检测心脏生物标志物。本研究的主要终点是PCI后心肌坏死，次要终点是慢性稳定型心绞痛患者在PCI情况下给予IC腺苷的安全性。
在最初随机分组的260例患者中，最终安慰剂组分析了83例患者，腺苷组分析了96例患者。研究患者在临床和血管造影特征方面具有可比性。患者的平均年龄为57.3岁（范围 = 35至79岁），71.5%为男性。研究组之间的平均血清心脏生物标志物无差异（安慰剂组肌酸激酶同工酶[CK.MB]平均水平为29.5±14.5 IU/L，对照组为31.5±18.5 IU/L；p值 = 0.41；安慰剂组心脏肌钙蛋白I（cTnI）平均水平为0.097±0.178 μg/L，对照组为0.167±0.5 μg/L；p值 = 0.24）。
尽管在直接PCI中取得了有前景的结果，但我们的研究表明，IC腺苷预处理策略在减少慢性稳定型心绞痛患者PCI后心肌坏死方面并无益处，不应常规使用。
