Abstract
Despite early recanalization of an occluded infarct artery, up to 33% of patients
with acute myocardial infarction do not obtain complete myocardial reperfusion due
to a process of reperfusion injury. This study assessed whether adjunctive therapy
with adenosine might prevent or attenuate the phenomenon of myocardial reperfusion
injury. Myocardial reperfusion was assessed in 79 consecutive patients receiving a
20-minute intracoronary infusion of adenosine during percutaneous coronary intervention
(PCI) and in a historical cohort of 200 patients with acute myocardial infarction
who were treated with PCI (controls). Myocardial reperfusion injury was defined as
persistent (≥50% of initial value) ST-segment elevation after successful recanalization.
Its effect on infarct size was evaluated by calculating the Selvester QRS score before
intervention and at follow-up. Myocardial reperfusion injury was present in 19% of
patients receiving adenosine versus 35% of control patients (p = 0.004). Evaluation
of infarct expansion over time showed almost no change in the QRS score in patients
receiving adenosine (3.4 ± 3.0 before PCI; 3.5 ± 3.1 at follow-up). In contrast, infarct
QRS score in the control group worsened from 3.1 ± 2.7 before PCI to 4.5 ± 3.2 at
follow-up (p = 0.003 treatment with adenosine vs control). Multivariate analysis identified
adjunctive therapy with adenosine as an independent protective determinant of myocardial
reperfusion injury and of infarct expansion. The rate of major adverse cardiac events
(death and myocardial infarction) at 1 month tended to be lower in patients receiving
adenosine (4% vs 6.5%, p = 0.7) and was mainly observed in patients with evidence
of myocardial reperfusion injury (cardiac event rate 2% in patients with ST-segment
elevation of <50% vs 14% in patients with ST-segment elevation ≥50%, p = 0.003). Thus,
impaired myocardial reperfusion is the most important determinant of clinical outcome
in patients with acute myocardial infarction treated with PCI. Adjunctive therapy
with intracoronary infusion of adenosine during PCI prevents the occurrence of severe
myocardial reperfusion injury and is associated with less infarct expansion.
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Article info
Publication history
Accepted:
March 12,
2004
Received in revised form:
March 12,
2004
Received:
November 6,
2003
Identification
Copyright
© 2004 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
