Adenosine as adjunctive therapy in acute coronary syndrome: a meta-analysis of randomized controlled trials

Renzo Laborante, Emiliano Bianchini, Attilio Restivo, Giuseppe Ciliberti, Mattia Galli, Rocco Vergallo, Daniele Rodolico, Andrea Zito, Giuseppe Princi, Antonio Maria Leone, Cristina Aurigemma, Enrico Romagnoli, Rocco Antonio Montone, Francesco Burzotta, Carlo Trani, Filippo Crea, Domenico D'Amario

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Aims: Adenosine has been tested in several randomized controlled trials (RCTs) to minimize the incidence of coronary microvascular 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.
Lingua originaleEnglish
pagine (da-a)173-182
Numero di pagine10
RivistaEUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY
Volume9
DOI
Stato di pubblicazionePubblicato - 2023

Keywords

  • Acute coronary syndrome
  • Adenosine
  • Coronary microvascular obstruction
  • Percutaneous coronary intervention
  • Ventricular fibrillation

Fingerprint

Entra nei temi di ricerca di 'Adenosine as adjunctive therapy in acute coronary syndrome: a meta-analysis of randomized controlled trials'. Insieme formano una fingerprint unica.

Cita questo