Adenosine Associated Pre- and Postconditioning in Real Medical Practice

Abstract

It has been established that adenosine is a universal trigger of the processes of preparation (conditioning) of the myocardium for ischemic injury, which is confirmed by randomized clinical trials AMISTAD II, TIMI-4, TIMI-9B. Adenosine is included in the guidelines of the ESC Task Force (European Society of Cardiology) as a means of basic therapy, as a representative of the class of potassium channel stimulants (2019) [1]. However, the use of adenosine as an injectable form for intracoronary or intravenous administration is associated with a number of side effects - rapid degradation of the drug in the bloodstream, the need for careful monitoring of systemic hemodynamics (hypotension, tachy- or bradyarrhythmia, ventricular tachycardia, atrioventricular block), frequent development of undesirable gastrointestinal manifestations. All this prompted the search for an alternative form of adenosine use, which would allow wider use of the potentially beneficial effect of adenosine on ischemic pre- and post-conditioning in real medical practice.
 More recently, on the pharmaceutical market of Ukraine for the first time appeared a pharmacological agent - Advocard, as a drug with the ability to start the processes of pre- and post-conditioning, with sublingual (oral) form of application. Advocard is an original combined polypill drug with three components: adenosine-5-triphosphate-gluconate-magnesium (II) trisodium salt (magladen) – 18,6-29,25 mg, molsidomine – 0,3 mg and folic acid - 0,45 mg. Recommendations for the use of the Advocard in medical practice are based on the results of clinical studies, which proved that the oral (sublingual) form of adenosine is not only effective and appropriate, but also safe with long-term use.
 The therapeutic efficacy of Advocard in chronic coronary syndromes [stable, vasospastic, microvascular angina (pain of small coronary vessels), painless myocardial ischemia] and acute coronary syndromes (STEMI / NSTEMI, instability to stenocardia) before or immediately after coronary stenting is in counteracting the mechanisms of reperfusion injury.
 Clinical practice has shown that Advocard is appropriate for the prevention of NO-REFLOW after opening the epicardial coronary artery, even with the result of TIMI-3. Thus, the Advocard opens the prospect of improving the effectiveness of coronary interventions and is an adjunct to complete myocardial revascularization.