European Heart Journal Advance Access originally published online on November 28, 2006
European Heart Journal 2007 28(1):19-25; doi:10.1093/eurheartj/ehl411
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Pretreatment with intracoronary adenosine reduces the incidence of myonecrosis after non-urgent percutaneous coronary intervention: a prospective randomized study
1 Cardiac Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
2 Center for Molecular Epidemiology and Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Received 16 June 2006; revised 20 October 2006; accepted 9 November 2006; online publish-ahead-of-print 28 November 2006.
* Corresponding author. Tel: +65 6772 2493; fax: + 65 6872 2998. E-mail address: leerch{at}hotmail.com
Aims We sought to investigate the effect of adenosine pretreatment on the incidence of myonecrosis after non-urgent percutaneous coronary intervention (PCI).
Methods and results This was a prospective, randomized, open-label study. Patients who were scheduled for non-urgent PCI in de novo native coronary arteries were eligible. All patients were pretreated with aspirin and clopidogrel. Myonecrosis was measured by creatine kinase-myocardial band (CK-MB) elevation after PCI. A total of 62 patients were randomized into the adenosine (n = 31) or standard (n = 31) group. The adenosine group received 50 µg adenosine bolus before wiring of each lesion, whereas the standard group did not. Post-PCI myonecrosis occurred more frequently in the standard group (39 vs. 13%, OR 0.23, 95% CI 0.05–0.95, P = 0.020). After adjustment for drug-eluting stent implantation, multi-vessel stenting, and elevated baseline troponin, the OR was 0.19 (95% CI 0.05–0.72, P = 0.017). The median peak values of CK-MB in the adenosine and standard groups were 2 and 4 µg/L, respectively (P = 0.033). The adjusted difference was 1.95 µg/L (95% CI 0.13–3.77, P = 0.037). The incidences of myocardial infarction (>3 x CK-MB) were 6 and 16% in the adenosine and standard groups, respectively (OR 0.36; 95% CI 0.03–2.46, P = 0.229).
Conclusion Pretreatment with 50 µg of adenosine decreases the incidence of myonecrosis after non-urgent PCI compared with that without pretreatment.
Key Words: Adenosine • Myonecrosis • Myocardial infarction • Coronary intervention