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European Heart Journal Advance Access originally published online on June 16, 2006
European Heart Journal 2006 27(20):2400-2405; doi:10.1093/eurheartj/ehl094
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Impact of time to therapy and reperfusion modality on the efficacy of adenosine in acute myocardial infarction: the AMISTAD-2 trial

Robert A. Kloner1,*, Mervyn B. Forman2,5, Raymond J. Gibbons3, Allan M. Ross4, R. Wayne Alexander5 and Gregg W. Stone6

1 Heart Institute, Good Samaritan Hospital, Cardiovascular Division of the Keck School of Medicine at University of Southern California, 1225 Wilshire Boulevard, Los Angeles, CA 90017, USA
2 North Atlanta Cardiovascular Associates, P.C., Atlanta, Georgia
3 Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, MN, USA
4 Department of Medicine, George, Washington University, Washington, DC, USA
5 Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
6 Columbia University Medical Center and the, Cardiovascular Research Foundation, New York, NY, USA

Received 25 March 2006; revised 19 May 2006; accepted 26 May 2006; online publish-ahead-of-print 16 June 2006.

* Corresponding author. +1 213 977 4040 or 977-4050; fax: +1 213 977 4107. E-mail address: rkloner{at}goodsam.org

See page 2376 for the editorial comment on this article (doi:10.1093/eurheartj/ehl268)

Aims The purpose of this analysis was to determine whether the efficacy of adenosine vs. placebo was dependent on the timing of reperfusion therapy in the second Acute Myocardial Infarction Study of Adenosine (AMISTAD-II).

Methods and results Patients presenting with ST-segment elevation anterior AMI were randomized to receive placebo vs. adenosine (50 or 70 µg/kg/min) for 3 h starting within 15 min of reperfusion therapy. In the present post hoc hypothesis generating study, the results were stratified according to the timing of reperfusion, i.e. ≥ or < the median 3.17 h, and by reperfusion modality. In patients receiving reperfusion <3.17 h, adenosine compared with placebo significantly reduced 1-month mortality (5.2 vs. 9.2%, respectively, P=0.014), 6-month mortality (7.3 vs. 11.2%, P=0.033), and the occurrence of the primary 6-month composite clinical endpoint of death, in-hospital CHF, or rehospitalization for CHF at 6 months (12.0 vs. 17.2%, P=0.022). Patients reperfused beyond 3 h did not benefit from adenosine.

Conclusion In this post hoc analysis, 3 h adenosine infusion administered as an adjunct to reperfusion therapy within the first 3.17 h onset of evolving anterior ST-segment elevation AMI enhanced early and late survival, and reduced the composite clinical endpoint of death or CHF at 6 months.

Key Words: Adenosine • Myocardial infarction • Thrombolysis • Fibrinolytic therapy • Percutaneous transluminal coronary angioplasty • Congestive heart failure


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