High dose adenosine for suboptimal myocardial reperfusion after primary PCI: A randomized placebo-controlled pilot study

Objectives: This study was designed to investigate the influence of high dose intracoronary adenosine on persistent ST-segment elevation after primary percutaneous coronary intervention (PCI). Background: After successful PCI for acute myocardial infarction 40-50% of patients show persistent ST-segment elevation indicating suboptimal myocardial reperfusion. Adenosine has been studied to ameliorate reperfusion and is frequently used in a variety of doses, but there are no prospective studies to support its use for treatment of suboptimal reperfusion. Methods: We conducted a blinded, randomized, and placebo-controlled study with high dose intracoronary adenosine in 51 patients with 70%) STRes compared with placebo (33% versus 9%, P <0.05). Mean STRes was higher after adenosine (35.4% versus 23.0%, P <0.05). In addition, TIMI frame count was significant lower (15.7 versus 30.2, P <0.005), Myocardial Blush Grade was higher (2.7 versus 2.0, P <0.05) and resistance index was lower in the adenosine group (0.70 versus 1.31 mm Hg per ml/min, P