Adenosine improves post-procedural coronary flow but not clinical outcomes in patients with acute coronary syndrome: A meta-analysis of randomized trials

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• 作者：Eliano Pio Navarese^a ; ^d ; ^{eliano.navarese@alice.it} ; Antonino Buffon^b ; Felicita Andreotti^b ; Paul Alfred Gurbel^c ; Marek Kozinski^a ; Aldona Kubica^e ; Giuseppe Musumeci^f ; Alberto Cremonesi^a ; Luigi Tavazzi^a ; Jacek Kubica^d ; Fausto Castriota^a
• 关键词：ACS ; Acute coronary syndromes ; CI ; confidence interval ; IC ; intracoronary adenosine ; IV ; intravenous adenosine ; h ; hours ; HF ; heart failure ; na ; not available ; OR ; odds ratio ; PCI ; percutaneous coronary intervention ; pts ; patients ; RCTs ; randomized contro
• 刊名：Atherosclerosis
• 出版年：2012
• 期刊代码：28_00219150
• 类别：med
• 出版时间：May, 2012
• 卷：222
• 期：1
• 页码：1-7
• 文件大小：1214 K

摘要

Aims

Adjunctive therapy with adenosine has been shown to improve coronary flow in patients with acute coronary syndromes (ACS); it is unclear, however, whether adenosine can effectively reduce adverse clinical events. The aim of our study was to perform a meta-analysis of all randomized controlled trials (RCTs) investigating angiographic and clinical outcomes in ACS patients undergoing PCI or thrombolysis and receiving adjunctive adenosine therapy vs. placebo.

Methods

Medline/CENTRAL/EMBASE and Google Scholar database were scanned. The meta-analysis included ten RCTs (N = 3821). All-cause mortality was chosen as primary endpoint. Secondary endpoints were re-infarction (MI), heart failure (HF) symptoms (NYHA class III/IV), no-reflow (defined as TIMI 0 flow) and >50%ST-resolution.

Results

Adenosine compared to placebo was associated with a significant reduction of post-procedural no-reflow (OR [95%CI] = 0.25 [0.08-0.73], p = 0.01); however, at a median follow-up of 6 months, prior treatment with adenosine did not confer significant benefits in terms of reduction of mortality (OR_Fixed [95%CI] = 0.87 [0.69-1.09], p = 0.23), as well as re-MI (p = 0.80), HF symptoms (p = 0.44) and ST-resolution (p = 0.09). Separate analyses conducted in the subgroups of ST-elevation MI patients treated with either PCI or thrombolysis confirmed the findings found in the overall population.

Conclusions

This meta-analysis shows that adenosine adjunctive therapy does not improve survival nor reduce the rates of re-MI and HF symptoms in patients with ACS treated with PCI or thrombolysis. The beneficial effect on post-procedural coronary flow was not associated with consistent advantages on clinical outcomes.