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

Eliano Pio Navarese, Antonino Buffon, Felicita Andreotti, Paul Alfred Gurbel, Marek Kozinski, Aldona Kubica, Giuseppe Musumeci, Alberto Cremonesi, Luigi Tavazzi, Jacek Kubica, Fausto Castriota

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalAtherosclerosis
Volume222
Issue number1
DOIs
StatePublished - May 2012

Keywords

  • Acute coronary syndrome
  • Adenosine
  • Clinical outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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