Feng Xue-Mei, Zhang Wen-Hui, Liu Jia
School of Basic Medical Sciences, Shanghai Jiaotong University, 200025 Shanghai, China.
Department of Digestive Oncology, Baotou Cancer Hospital, 014030 Baotou, Inner Mongolia, China.
Rev Cardiovasc Med. 2025 Feb 12;26(2):24065. doi: 10.31083/RCM24065. eCollection 2025 Feb.
Adenosine administration can improve coronary blood flow in patients undergoing primary percutaneous coronary intervention (PCI); however, the therapeutic effects of adenosine on ST resolution and major adverse cardiovascular events (MACEs) after PCI remain unclear. This study aimed to assess the therapeutic effects of adjunctive adenosine administration on patients with acute myocardial infarction (AMI) undergoing PCI using a meta-analytic approach.
We conducted a systematic search across PubMed, Embase, and the Cochrane Library to identify eligible randomized controlled trials (RCTs) published from inception through to March 2024. Primary outcomes included ST resolution and MACEs. The pooled analyses were all conducted using the random-effects model. Additionally, exploratory analyses were carried out through the application of sensitivity and subgroup analyses.
Twenty-one RCTs involving 2467 patients with AMI were selected for the meta-analysis. Adenosine significantly increased the incidence of ST resolution (relative risk [RR]: 1.30; 95% confidence interval [CI]: 1.15-1.46; < 0.001), while it significantly reduced the risk of MACEs (RR: 0.67; 95% CI: 0.51-0.87; = 0.003). Moreover, the use of adenosine was associated with reduced incidences of no reflow (RR: 0.35; 95% CI: 0.24-0.52; < 0.001) and myocardial blush grade (MBG) 0 to 1 (RR: 0.75; 95% CI: 0.58-0.99; = 0.041). Furthermore, adenosine significantly reduced the risk of heart failure (RR: 0.66; 95% CI: 0.44-0.99; = 0.044). Finally, adenosine use was associated with a lower creatine kinase-MB (CK-MB) peak value (weighted mean difference: -36.94; 95% CI: -73.76- -0.11; = 0.049).
This study revealed that adenosine use was associated with an increased incidence of ST resolution, and reduced risk of MACEs.
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腺苷给药可改善接受直接经皮冠状动脉介入治疗（PCI）患者的冠状动脉血流；然而，腺苷对PCI术后ST段回落和主要不良心血管事件（MACE）的治疗效果仍不明确。本研究旨在采用荟萃分析方法评估辅助使用腺苷对接受PCI的急性心肌梗死（AMI）患者的治疗效果。
我们在PubMed、Embase和Cochrane图书馆进行了系统检索，以确定从开始到2024年3月发表的符合条件的随机对照试验（RCT）。主要结局包括ST段回落和MACE。所有汇总分析均采用随机效应模型进行。此外，通过敏感性分析和亚组分析进行探索性分析。
21项涉及2467例AMI患者的RCT被纳入荟萃分析。腺苷显著提高了ST段回落的发生率（相对危险度[RR]：1.30；95%置信区间[CI]：1.15 - 1.46；P < 0.001），同时显著降低了MACE的风险（RR：0.67；95% CI：0.51 - 0.87；P = 0.003）。此外，使用腺苷与无复流发生率降低（RR：0.35；95% CI：0.24 - 0.52；P < 0.001）和心肌 blush分级（MBG）0至1级发生率降低（RR：0.75；95% CI：0.58 - 0.99；P = 0.041）相关。此外，腺苷显著降低了心力衰竭的风险（RR：0.66；95% CI：0.44 - 0.99；P = 0.044）。最后，使用腺苷与较低的肌酸激酶-MB（CK-MB）峰值相关（加权平均差：-36.94；95% CI：-73.76 - -（此处疑似有误，推测应为-0.11）；P = 0.049）。
本研究表明，使用腺苷与ST段回落发生率增加以及MACE风险降低相关。
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