Effect of Intracoronary Adenosine on No-Reflow in Patients With Acute ST-Elevation Myocardial Infarction Undergoing Primary PCI: A Randomized Controlled Trial.
Ahmed Saad, Oluwakorede Akele, Vaishvik Patel et al.
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In 30 seconds
This single-center randomized controlled trial assessed intracoronary adenosine after TIMI 1 flow was established during primary PCI in 200 patients with STEMI. Compared with standard care, adenosine was associated with less angiographic no-reflow (33% vs 60%, p < 0.001), more TIMI III flow (86% vs 49%, p < 0.001), and more myocardial blush grade III (68% vs 42%, p = 0.003). Post-PCI left ventricular ejection fraction was also higher with adenosine. The authors describe the findings as preliminary, noting the absence of long-term clinical outcomes.
Key findings
- No-reflow incidence was 33% with adenosine versus 60% with standard care (p < 0.001).
- TIMI III flow occurred in 86% versus 49% (p < 0.001), and myocardial blush grade III in 68% versus 42% (p = 0.003).
- Post-PCI left ventricular ejection fraction was 42.64 ± 8.92% with adenosine versus 38.40 ± 9.34% with standard care (p = 0.001).
Why it matters
No-reflow is associated with adverse outcomes after primary PCI for STEMI. This trial suggests that intracoronary adenosine given after TIMI 1 flow is achieved may improve angiographic reperfusion and early measures of ventricular function. These findings are clinically relevant as evidence about a potential procedural adjunct, but they do not establish a long-term clinical benefit.
What to keep in mind
The trial was single-center, and long-term clinical outcomes were not assessed; the authors state that external validation is needed.