학술논문
Adenosine as adjunctive therapy in acute coronary syndrome: a meta-analysis of randomized controlled trials
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Academic Journal
Author
Laborante, Renzo; Bianchini, Emiliano; Restivo, Attilio; Ciliberti, Giuseppe; Galli, Mattia; Vergallo, Rocco; Rodolico, Daniele; Zito, Andrea; Princi, Giuseppe; Leone, Antonio Maria; Aurigemma, Cristina; Romagnoli, Enrico; Montone, Rocco Antonio; Burzotta, Francesco; Trani, Carlo; Crea, Filippo; D'Amario, Domenico
Source
European Heart Journal: Cardiovascular Pharmacotherapy. March 2023, Vol. 9 Issue 2, p173, 10 p.
Subject
Language
English
ISSN
2055-6837
Abstract
Abbreviations ACS acute coronary syndrome AV atrio-ventricular CI confidence interval MACE major adverse cardiac events PCI percutaneous coronary intervention RCT randomized controlled trial VF/SVT ventricular fibrillation/sustained ventricular tachycardia Introduction A [...]
Aims Adenosine has been tested in several randomized controlled trials (RCTs) to minimize the incidence of coronary mi- crovascular obstruction (CMVO). The aim of this study was to pool all the RCTs comparing intracoronary or intravenous adenosine versus placebo in patients with acute coronary syndrome (ACS) undergoing myocardial revascularization. Methods and results PubMed and Scopus electronic databases were scanned for eligible studies up to 5th June 2022. A total of 26 RCTs with 5843 patients were included. Efficacy endpoints were major adverse cardiac events (MACE), all-cause death, non-fatal myocardial infarction, and heart failure. Atrioventricular blocks and ventricular fibrillation/sustained ventricular tachycardia (VF/SVT) were the safety endpoints. Myocardial blush grade, thrombolysis in myocardial infarction (TIMI) flow grade, left ventricular ejection fraction (LVEF), infarct size, and ST-segment resolution were also assessed. Adenosine administration was not associated with any clinical benefit in terms of MACE, all-cause death, non-fatal myocardial infarction, and heart failure. However, adenosine was associated with an increased rate of advanced atrioventricular blocks and of VF/SVT in studies with total mean ischaemic time >3 h, compared to placebo. Remarkably, among patients undergoing percutaneous coronary intervention, adenosine was associated with reduced myocardial blush grade 0-1 and TIMI flow grade 0-2, compared to placebo. Furthermore, adenosine did not show favourable effects on LVEF and infarct size. Conclusion Adenosine infusion, as adjunctive therapy in ACS, was associated with an increased risk of advanced atrioventricular blocks and increased rates of adenosine-triggered ventricular arrhythmias in patients with long ischaemic time, without providing any clinical benefit compared to placebo. Adenosine * Acute coronary syndrome * Coronary microvascular obstruction * Percutaneous coronary intervention * Ventricular fibrillation
Aims Adenosine has been tested in several randomized controlled trials (RCTs) to minimize the incidence of coronary mi- crovascular obstruction (CMVO). The aim of this study was to pool all the RCTs comparing intracoronary or intravenous adenosine versus placebo in patients with acute coronary syndrome (ACS) undergoing myocardial revascularization. Methods and results PubMed and Scopus electronic databases were scanned for eligible studies up to 5th June 2022. A total of 26 RCTs with 5843 patients were included. Efficacy endpoints were major adverse cardiac events (MACE), all-cause death, non-fatal myocardial infarction, and heart failure. Atrioventricular blocks and ventricular fibrillation/sustained ventricular tachycardia (VF/SVT) were the safety endpoints. Myocardial blush grade, thrombolysis in myocardial infarction (TIMI) flow grade, left ventricular ejection fraction (LVEF), infarct size, and ST-segment resolution were also assessed. Adenosine administration was not associated with any clinical benefit in terms of MACE, all-cause death, non-fatal myocardial infarction, and heart failure. However, adenosine was associated with an increased rate of advanced atrioventricular blocks and of VF/SVT in studies with total mean ischaemic time >3 h, compared to placebo. Remarkably, among patients undergoing percutaneous coronary intervention, adenosine was associated with reduced myocardial blush grade 0-1 and TIMI flow grade 0-2, compared to placebo. Furthermore, adenosine did not show favourable effects on LVEF and infarct size. Conclusion Adenosine infusion, as adjunctive therapy in ACS, was associated with an increased risk of advanced atrioventricular blocks and increased rates of adenosine-triggered ventricular arrhythmias in patients with long ischaemic time, without providing any clinical benefit compared to placebo. Adenosine * Acute coronary syndrome * Coronary microvascular obstruction * Percutaneous coronary intervention * Ventricular fibrillation