Preconditioning of human myocardium with adenosine during coronary angioplasty

Massoud A. Leesar, Marcus Stoddard, Mirza Ahmed, John Broadbent, Roberto Bolli

Research output: Contribution to journalArticle

Abstract

Background: It is unknown whether adenosine can precondition human myocardium against ischemia in vivo. Methods and Results: Thirty patients were randomized to receive a 10-minute intracoronary infusion of adenosine (2 mg/min) or normal saline; 10 minutes later, they underwent percutaneous transluminal coronary angioplasty (PTCA; three 2-minute balloon inflations 5 minutes apart). In control patients, the ST-segment shift on the intracoronary ECG was significantly greater during the first inflation than during the second and third inflations, consistent with ischemic preconditioning. In contrast, in adenosine-treated patients, there were no differences in ST-segment shift during the three inflations. The ST-segment shift was significantly smaller in the adenosine-treated group compared with the control group during all three inflations. The reduction in ST-segment shift afforded by adenosine during the first inflation (-72% versus first inflation in control subjects) was greater than that afforded by ischemic preconditioning in control subjects (-52% during the third versus first inflation). Measurements of chest pain score paralleled those of ST-segment shift. Adenosine had no effect on baseline regional wall motion as determined by quantitative two-dimensional echocardiography. Thus, intracoronary infusion of adenosine before PTCA rendered the myocardium remarkably resistant to subsequent ischemia. Judging from the intracoronary ECG, the protection provided by adenosine was even superior to that provided in control subjects by the ischemia associated with the first two balloon inflations. Infusion of adenosine had no major adverse effects in patients undergoing PTCA of the left anterior descending or circumflex arteries. Conclusions: Adenosine preconditions human myocardium against ischemia in vivo. Pretreatment with adenosine is remarkably effective (even more effective than ischemic preconditioning) and could he used prophylactically to attenuate ischemia in selected patients undergoing PTCA of the left anterior descending coronary artery. Whether adenosine can be safely infused into the right or the circumflex coronary artery in the presence of a temporary pacemaker remains to be established.

Original languageEnglish (US)
Pages (from-to)2500-2507
Number of pages8
JournalCirculation
Volume95
Issue number11
StatePublished - 1997
Externally publishedYes

Fingerprint

Angioplasty
Adenosine
Myocardium
Economic Inflation
Ischemia
Ischemic Preconditioning
Coronary Vessels
Electrocardiography
Coronary Balloon Angioplasty
Chest Pain
Echocardiography
Arteries
Control Groups

Keywords

  • adenosine
  • angioplasty
  • ischemia

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Leesar, M. A., Stoddard, M., Ahmed, M., Broadbent, J., & Bolli, R. (1997). Preconditioning of human myocardium with adenosine during coronary angioplasty. Circulation, 95(11), 2500-2507.

Preconditioning of human myocardium with adenosine during coronary angioplasty. / Leesar, Massoud A.; Stoddard, Marcus; Ahmed, Mirza; Broadbent, John; Bolli, Roberto.

In: Circulation, Vol. 95, No. 11, 1997, p. 2500-2507.

Research output: Contribution to journalArticle

Leesar, MA, Stoddard, M, Ahmed, M, Broadbent, J & Bolli, R 1997, 'Preconditioning of human myocardium with adenosine during coronary angioplasty', Circulation, vol. 95, no. 11, pp. 2500-2507.
Leesar MA, Stoddard M, Ahmed M, Broadbent J, Bolli R. Preconditioning of human myocardium with adenosine during coronary angioplasty. Circulation. 1997;95(11):2500-2507.
Leesar, Massoud A. ; Stoddard, Marcus ; Ahmed, Mirza ; Broadbent, John ; Bolli, Roberto. / Preconditioning of human myocardium with adenosine during coronary angioplasty. In: Circulation. 1997 ; Vol. 95, No. 11. pp. 2500-2507.
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AB - Background: It is unknown whether adenosine can precondition human myocardium against ischemia in vivo. Methods and Results: Thirty patients were randomized to receive a 10-minute intracoronary infusion of adenosine (2 mg/min) or normal saline; 10 minutes later, they underwent percutaneous transluminal coronary angioplasty (PTCA; three 2-minute balloon inflations 5 minutes apart). In control patients, the ST-segment shift on the intracoronary ECG was significantly greater during the first inflation than during the second and third inflations, consistent with ischemic preconditioning. In contrast, in adenosine-treated patients, there were no differences in ST-segment shift during the three inflations. The ST-segment shift was significantly smaller in the adenosine-treated group compared with the control group during all three inflations. The reduction in ST-segment shift afforded by adenosine during the first inflation (-72% versus first inflation in control subjects) was greater than that afforded by ischemic preconditioning in control subjects (-52% during the third versus first inflation). Measurements of chest pain score paralleled those of ST-segment shift. Adenosine had no effect on baseline regional wall motion as determined by quantitative two-dimensional echocardiography. Thus, intracoronary infusion of adenosine before PTCA rendered the myocardium remarkably resistant to subsequent ischemia. Judging from the intracoronary ECG, the protection provided by adenosine was even superior to that provided in control subjects by the ischemia associated with the first two balloon inflations. Infusion of adenosine had no major adverse effects in patients undergoing PTCA of the left anterior descending or circumflex arteries. Conclusions: Adenosine preconditions human myocardium against ischemia in vivo. Pretreatment with adenosine is remarkably effective (even more effective than ischemic preconditioning) and could he used prophylactically to attenuate ischemia in selected patients undergoing PTCA of the left anterior descending coronary artery. Whether adenosine can be safely infused into the right or the circumflex coronary artery in the presence of a temporary pacemaker remains to be established.

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