Does high-dose intracoronary adenosine improve regional systolic left ventricular function in patients with acute myocardial infarction?

Abstract

Background Reperfusion injury limits the beneficial effects of primary percutaneous coronary intervention (PCI) in the setting of acute myocardial infarction (AMI). Adenosine limits reperfusion injury in animal models. Objective Is to study the effects of high-dose intracoronary adenosine administration in the setting of primary PCI on coronary blood flow and regional left ventricular function. Methods Sixty patients with a definite diagnosis of ST elevation AMI within 6 h from the onset of chest pain were randomly allocated to receive adenosine (6 mg) or saline placebo (on a 1:2 ratio) as an adjunct to primary PCI with assessment of TIMI flow, TIMI myocardial blush grade (MBG), and occurrence of no-reflow. Systolic (S) wave velocity was recorded at the mitral annulus in the territory of the infarct related artery using pulsed-wave tissue Doppler within 24 h from admission and one week after PCI. Results Both groups showed no significant difference in terms of age, sex, risk factors, infarct location, and distribution of coronary artery disease. The adenosine group showed a higher incidence of TIMI III flow (95% vs. 65%, p < 0.03), a higher incidence of MBG 2-3 (95% vs. 67.5%, p < 0.007), and a lower incidence of no-reflow (10% vs. 45%, p < 0.006). Only in the adenosine group, there was a significant improvement in the annular pulsed tissue Doppler S wave velocity at the infarct-related territory at day-7 (p < 0.01). Conclusion High-dose adenosine administration in the setting of primary PCI improves myocardial perfusion and regional left ventricular systolic function.