Does high-dose intracoronary adenosine improve regional systolic left ventricular function in patients with acute myocardial infarction?

Background: Reperfusion injury limits the beneficial effects of primary percutaneous coronary intervention (PCI) in the setting of acute myocardial infarction (AMI). Adenosine limits reperfusion injury in animal models. Objective: Is to study the effects of high-dose intracoronary adenosine administration in the setting of primary PCI on coronary blood flow and regional left ventricular function. Methods: Sixty patients with a definite diagnosis of ST elevation AMI within 6 h from the onset of chest pain were randomly allocated to receive adenosine (6 mg) or saline placebo (on a 1:2 ratio) as an adjunct to primary PCI with assessment of TIMI flow, TIMI myocardial blush grade (MBG), and occurrence of no-reflow. Systolic (S) wave velocity was recorded at the mitral annulus in the territory of the infarct related artery using pulsed-wave tissue Doppler within 24 h from admission and one week after PCI. Results: Both groups showed no significant difference in terms of age, sex, risk factors, infarct location, and distribution of coronary artery disease. The adenosine group showed a higher incidence of TIMI III flow (95% vs. 65%, p < 0.03), a higher incidence of MBG 2-3 (95% vs. 67.5%, p < 0.007), and a lower incidence of no-reflow (10% vs. 45%, p < 0.006). Only in the adenosine group, there was a significant improvement in the annular pulsed tissue Doppler S wave velocity at the infarct-related territory at day-7 (p < 0.01). Conclusion: High-dose adenosine administration in the setting of primary PCI improves myocardial perfusion and regional left ventricular systolic function