Clinical benefit of adenosine as an adjunct to reperfusion in ST-elevation myocardial infarction patients : An updated meta-analysis of randomized controlled trials
Bulluck, Heerajnarain (The Heart Hospital)
Sirker, Alex (The Heart Hospital)
Loke, Yoon K. (University of East Anglia)
García-Dorado, David (Hospital Universitari Vall d'Hebron)
Hausenloy, Derek J. (National Heart Research Institute Singapore)
Universitat Autònoma de Barcelona

Date:	2016
Abstract:	Adenosine administered as an adjunct to reperfusion can reduce coronary no-reflow and limit myocardial infarct (MI) size in ST-segment elevation myocardial infarction (STEMI) patients. Whether adjunctive adenosine therapy can improve clinical outcomes in reperfused STEMI patients is not clear and is investigated in this meta-analysis of 13 randomized controlled trials (RCTs). We performed an up-to-date search for all RCTs investigating adenosine as an adjunct to reperfusion in STEMI patients. We calculated pooled relative risks using a fixed-effect meta-analysis assessing the impact of adjunctive adenosine therapy on major clinical endpoint including all-cause mortality, non-fatal myocardial infarction, and heart failure. Surrogate markers of reperfusion were also analyzed. 13 RCTs (4273 STEMI patients) were identified and divided into 2 subgroups: intracoronary adenosine versus control (8 RCTs) and intravenous adenosine versus control (5 RCTs). In patients administered intracoronary adenosine, the incidence of heart failure was significantly lower (risk ratio [RR] 0. 44 [95% CI 0. 25-0. 78], P = 0. 005) and the incidence of coronary no-reflow was reduced (RR for TIMI flow<3 postreperfusion 0. 68 [95% CI 0. 47-0. 99], P = 0. 04). There was no difference in heart failure incidence in the intravenous adenosine group but most RCTs in this subgroup were from the thrombolysis era. There was no difference in non-fatal MI or all-cause mortality in both subgroups. We find evidence of improved clinical outcome in terms of less heart failure in STEMI patients administered intracoronary adenosine as an adjunct to reperfusion. This finding will need to be confirmed in a large adequately powered prospective RCT.
Note:	This work was supported by the British Heart Foundation (FS/10/039/28270), the RoseTrees Trust, and the National Institute for HealthResearch University College London Hospitals Biomedical Research Centre.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Primary percutaneous coronary intervention ; Adenosine ; ST-segment elevation myocardial infarction ; Reperfusion injury ; Adjunctive therapy
Published in:	International Journal of Cardiology, Vol. 202 (january 2016) , p. 228-237, ISSN 1874-1754

DOI: 10.1016/j.ijcard.2015.09.005
PMID: 26402450

10 p, 1.1 MB

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