Myocardial protective effect of adenosine during percutaneous coronary intervention in patients with acute myocardial infarction

Objective To evaluate the myocardial protective effect of intracoronary adenosine infusion in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI). Methods Forty-two AMI patients who received PCI successfully were randomly divided into two groups.After the balloon was inflated, adenosine(300 μg) and saline(10 ml) were immediately injected by intracoronary injection in adenosine group and saline was injected in control group within one minute. Then the stenting was performed. Coronary flow of infarction related artery(IRA) was assessed by the method of thrombolysis in myocardial infarction trial(TIMI) grading. Serum levels of creatine kinase(CK), MB isoenzyme of creatine kinase(CK-MB),cardiac troponin I(cTnI) were measured at 4 h,8 h, 12 h, 16 h, 20 h and 24 h after PCI. Sum of ST-segment resolution(sumSTR) was measured at 1 hour after PCI. The left ventricular ejection fraction(LVEF) by echocardiogram was evaluated at the third day and fourth week after PCI. Results Serum peak levels of CK, CK-MB and cTnI in adenosine group were significantly lower than those in saline group[median(25%,75% percentiles) CK 1 170 (730, 2 169 ) U/L vs 1 610 ( 1 056 , 3 598 ) U/L , CK-MB 128(98,168) U/L vs 178(125,345) U/L , cTnI 17.5 ( 12.9 , 20.6 ) μg/L vs 25.9 ( 17.5 , 58.9 ) μg/L ](all P 0.05 ). Sum STR one hour after PCI of adenosine group was significantly higher than that of saline group[median(25%,75% percentiles) 72%(64%,82%) vs 55(25%,65%)](P 0.05 ). LVEF in both adenosine and control group at the fourth week after PCI was significantly improved than that at the third day, adenosine group ( 56.67 ± 6.14 )% vs ( 50.19 ± 4.24 )%, control group ( 53.05 ± 4.67 )% vs ( 47.62 ± 4.18 )%(P 0.05 ). But LVEF at the third day between two groups after PCI showed no significant difference ( 50.19 ± 4.24 )% vs ( 47.62 ± 4.18 )% (P 0.05 ). LVEF of the fourth week after PCI in adenosine group was significantly improved than that of saline group( 56.67 ± 6.14 )% vs ( 53.05 ± 4.67 )%(P 0.05 ). Conclusion Intracoronary adenosine infusion during PCI significantly alleviated ischemia-reperfusion injury in AMI, ameliorated myocardial reperfusion and improved the left ventricular function. Intracoronary adenosine infusion in the patients with AMI during PCI was safe and feasible.