NEW YORK (Reuters Health) – Contrary to some previous results, intracoronary administration of a bolus of adenosine before elective percutaneous coronary intervention does not reduce periprocedural myocardial necrosis, Italian researchers report in the American Journal of Cardiology online October 17.
In fact, by one measure, “adenosine was associated with a greater occurrence of myonecrosis,” the authors point out. “However, no difference was observed in terms of periprocedural MI.”
Dr. Giuseppe De Luca and colleagues at Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University in Novara, explain that myocardial necrosis occurs during PCI in about 30% of cases because of occlusion of side branches, coronary spasm, and distal embolization. A recent study showed that intracoronary pretreatment with a relatively low dose of adenosine (30 – 60 mcg) prevented periprocedural MI.
The current study aimed to evaluate the benefits of a higher dose of adenosine: 120 mcg for the right coronary artery and 180 mcg for the left coronary artery. The team randomized 260 patients undergoing elective coronary angioplasty to receive placebo or adenosine through the guiding catheter, just before crossing the lesion with the wire.
The primary endpoint was periprocedural myonecrosis, defined as a peak troponin I level at least 3 times higher than the upper limit of normal. This was documented in 67.7% of the adenosine group and 70% of the placebo group (adjusted odds ratio 0.93, p=0.79), the investigators found.
A secondary measure using a peak troponin I level of more than 10 times the upper limit of normal occurred in more adenosine patients than placebo patients: 54.6% vs 43.1% (adjusted OR 1.78, p=0.03); the report indicates. However, rates of periprocedural MI, based on CK-MB levels at least 3 times greater than normal, were not significantly different at 12.3% and 10.0% (adjusted OR 1.65, p=0.25).
While no serious side effects were seen with adenosine as administered in this trial, Dr. De Luca and colleagues conclude that it provided no benefit. “Whether continuous periprocedural intravenous infusion or prolonged pre- and postprocedural intracoronary adenosine infusion would be beneficial in the setting of elective coronary angioplasty should be tested in future randomized trials,” they suggest.
Reference:
Am J Cardiol 2011.
