Intracoronary adenosine as an adjunct to primary coronary intervention in acute myocardial infarction

Abstract

The beneficial effects of primary percutaneous coronary intervention (PCI) in the setting of acute myocardial infarction (AMI) are limited by reperfusion injury. Adenosine limits reperfusion injury in animal models. The aim is to study the effects of intracoronary adenosine administration in the setting of primary PCI on the coronary blood flow and left ventricular function. Sixty patients with a definite diagnosis of ST elevation AMI within 6 h of onset of chest pain were randomly allocated to receive adenosine or saline (on a 1:2 ratio) as an adjunct to primary PCI with assessment of postintervention TIMI flow and TIMI myocardial perfusion grading (TMP). 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. 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 higher incidence of TIMI III flow (95% vs. 65%; p < 0.03), higher incidence of TMP grade 3 (85% vs. 40%; p < 0.007), and lower incidence of no-reflow (10% vs. 45%; p < 0.006). Only in the adenosine group, there was a significant improvement in S wave velocity at the infarct-related territory at day- 7 ( P < 0.01). Adenosine administration in the setting of primary PCI improves myocardial perfusion and early post-infarction regional LV systolic function.