Skip to main content

Advertisement

SpringerLink
Log in

Impact of Intracoronary Adenosine on Myonecrosis in Patients with Unstable Angina Pectoris Undergoing Percutaneous Coronary Intervention

  • ORIGINAL ARTICLE
  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Background

In this study, we aimed to investigate the impact of prophylactic intracoronary adenosine administered during percutaneous coronary intervention (PCI) due to unstable angina pectoris on myonecrosis by measuring post-procedural levels of cardiac troponin I (cTnI) and creatine kinase-myocardial band (CK-MB).

Methods

A total of 122 patients with unstable angina undergoing PCI were included in this single-center, double-blind, randomized study. The patients were randomly allocated to adenosine and placebo groups. In the adenosine group, a single-dose of intracoronary adenosine (100 μg for the right coronary artery and 150 μg for the left coronary artery) was administered. Primary endpoint was post-PCI myonecrosis, which was defined as abnormal levels of periprocedural cTnI. Secondary endpoints were defined as elevated cTnI levels [5 × upper limit of normal (ULN)], abnormal CK-MB levels, angiographic coronary flow measured by Thrombolysis In Myocardial Infarction (TIMI) frame count (TFC), the cumulative incidence of in-hospital death and in-hospital urgent target vessel revascularization (TVR).

Results

Clinical and angiographic characteristics of both adenosine (61 patients, 61 ± 9 years) and placebo (61 patients, 59 ± 10 years) groups were similar (p > 0.05 for all). Post-procedural abnormal cTnI levels in the adenosine group were significantly lower than the placebo group (32 % vs. 55 %, p: 0.011). cTnI >5 × ULN (21 % vs. 31 %, p: 0.217) and abnormal CK-MB levels (11 % vs. 19 %, p: 0.263) were similar in both groups. Post-procedural TFCs in the adenosine group were significantly lower than the placebo group (24 ± 4 vs. 27 ± 5, p: 0.004). In-hospital events including death and urgent TVR were not observed in either group.

Conclusion

Intracoronary administration of single-dose adenosine in patients with unstable angina undergoing PCI is associated with decreased periprocedural myonecrosis and improved coronary blood flow.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kini AS, Lee P, Marmur JD, Agarwal A, Duffy ME, Kim MC, Sharma SK. Correlation of postpercutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality. Am J Cardiol. 2004;93:18–23.

    Article  CAS  PubMed  Google Scholar 

  2. Nageh T, Sherwood RA, Harris BM, Byrne JA, Thomas MR. Cardiac troponin T and I and creatine kinase-MB as markers of myocardial injury and predictors of outcome following percutaneous coronary intervention. Int J Cardiol. 2003;92:285–93.

    Article  PubMed  Google Scholar 

  3. Brener SJ, Ellis SG, Schneider J, Topol EJ. Frequency and long-term impact of myonecrosis after coronary stenting. Eur Heart J. 2002;23:869–76.

    Article  CAS  PubMed  Google Scholar 

  4. Topol EJ, Yadav JS. Recognition of the importance of embolization in atherosclerotic vascular disease. Circulation. 2000;101:570–80.

    Article  CAS  PubMed  Google Scholar 

  5. Saber RS, Edwards WD, Bailey KR, McGovern TW, Schwartz RS, Holmes Jr DR. Coronary embolization after balloon angioplasty or thrombolytic therapy: an autopsy study of 32 cases. J Am Coll Cardiol. 1993;22:1283–8.

  6. Bonderman D, Teml A, Jakowitsch J, Adlbrecht C, Gyöngyösi M, Sperker W, Lass H, Mosgoeller W, Glogar DH, Probst P, Maurer G, Nemerson Y, Lang IM. Coronary no-reflow is caused by shedding of active tissue factor from dissected atherosclerotic plaque. Blood. 2002;99:2794–800.

    Article  CAS  PubMed  Google Scholar 

  7. Mallat Z, Hugel B, Ohan J, Lesèche G, Freyssinet JM, Tedgui A. Shed membrane microparticles with procoagulant potential in human atherosclerotic plaques: a role for apoptosis in plaque thrombogenicity. Circulation. 1999;99:348–53.

    Article  CAS  PubMed  Google Scholar 

  8. Mallat Z, Benamer H, Hugel B, Benessiano J, Steg PG, Freyssinet JM, Tedgui A. Elevated levels of shed membrane microparticles with procoagulant potential in the peripheral circulating blood of patients with acute coronary syndromes. Circulation. 2000;101:841–3.

    Article  CAS  PubMed  Google Scholar 

  9. Fischell TA, Derby G, Tse TM, Stadius ML. Coronary artery vasoconstriction routinely occurs after percutaneous transluminal coronary angioplasty. A quantitative arteriographic analysis. Circulation. 1988;78:1323–34.

    Article  CAS  PubMed  Google Scholar 

  10. Sato A, Terata K, Miura H, Toyama K, Loberiza Jr FR, Hatoum OA, Saito T, Sakuma I, Gutterman DD. Mechanism of vasodilation to adenosine in coronary arterioles from patients with heart disease. Am J Physiol Heart Circ Physiol. 2005;288:H1633–40.

    Article  CAS  PubMed  Google Scholar 

  11. Grygier M, Araszkiewicz A, Lesiak M, Janus M, Kowal J, Skorupski W, Pyda M, Mitkowski P, Grajek S. New method of intracoronary adenosine injection to prevent microvascular reperfusion injury in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Am J Cardiol. 2011;107:1131–5.

    Article  CAS  PubMed  Google Scholar 

  12. Marzilli M, Orsini E, Marraccini P, Testa R. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Circulation. 2000;101:2154–9.

    Article  CAS  PubMed  Google Scholar 

  13. Claeys MJ, Bosmans J, De Ceuninck M, Beunis A, Vergauwen W, Vorlat A, Vrints CJ. Effect of intracoronary adenosine infusion during coronary intervention on myocardial reperfusion injury in patients with acute myocardial infarction. Am J Cardiol. 2004;94:9–13.

    Article  CAS  PubMed  Google Scholar 

  14. Kloner RA, Forman MB, Gibbons RJ, Ross AM, Alexander RW, Stone GW. Impact of time to therapy and reperfusion modality on the efficacy of adenosine in acute myocardial infarction: the AMISTAD-2 trial. Eur Heart J. 2006;27:2400–5.

    Article  CAS  PubMed  Google Scholar 

  15. De Luca G, Iorio S, Venegoni L, Marino P. Evaluation of intracoronary adenosine to prevent periprocedural myonecrosis in elective percutaneous coronary intervention (from the PREVENT-ICARUS trial). Am J Cardiol. 2012;109:202–7.

    Article  PubMed  Google Scholar 

  16. Lee CH, Low A, Tai BC, Co M, Chan MY, Lim J, Lim YT, Tan HC. Pretreatment with intracoronary adenosine reduces the incidence of myonecrosis after non-urgent percutaneous coronary intervention: a prospective randomized study. Eur Heart J. 2007;28:19–25.

    Article  PubMed  Google Scholar 

  17. Amsterdam EA, Wenger NK, Brindis RG, Casey Jr DE, Ganiats TG, Holmes Jr DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, et al. American college of cardiology; American heart association task force on practice guidelines; society for cardiovascular angiography and interventions; society of thoracic surgeons; American association for clinical chemistry. 2014 AHA/ACC guideline for the management of patients with Non-ST-elevation acute coronary syndromes: a report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol. 2014;64:139–228.

    Article  Google Scholar 

  18. Smith Jr SC, Feldman TE, Hirshfeld Jr JW, Jacobs AK, Kern MJ, King 3rd SB, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Smith Jr SC, Adams CD, Anderson JL, et al. American college of cardiology/American heart association task force on practice guidelines; ACC/AHA/SCAI writing committee to update the 2001 guidelines for percutaneous coronary intervention. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American college of cardiology/American heart association task force on practice guidelines (ACC/AHA/SCAI writing committee to update the 2001 guidelines for percutaneous coronary intervention). J Am Coll Cardiol. 2006;47:e1–121.

    Article  PubMed  Google Scholar 

  19. Klein LW, Kern MJ, Berger P, Sanborn T, Block P, Babb J, Tommaso C, Hodgson JM, Feldman T. Interventional cardiology committee of the society of cardiac angiography and interventions. Society of cardiac angiography and interventions: suggested management of the no-reflow phenomenon in the cardiac catheterization laboratory. Catheter Cardiovasc Interv. 2003;60:194–201.

    Article  PubMed  Google Scholar 

  20. Gibson CM, Cannon CP, Daley WL, Dodge Jr JT, Alexander Jr B, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93:879–88.

    Article  CAS  PubMed  Google Scholar 

  21. Califf RM, Abdelmeguid AE, Kuntz RE, Popma JJ, Davidson CJ, Cohen EA, Kleiman NS, Mahaffey KW, Topol EJ, Pepine CJ, Lipicky RJ, Granger CB, Harrington RA, Tardiff BE, Crenshaw BS, Bauman RP, Zuckerman BD, Chaitman BR, Bittl JA, Ohman EM. Myonecrosis after revascularization procedures. J Am Coll Cardiol. 1998;31:241–51.

    Article  CAS  PubMed  Google Scholar 

  22. Mehran R, Dangas G, Mintz GS, Lansky AJ, Pichard AD, Satler LF, Kent KM, Stone GW, Leon MB. Atherosclerotic plaque burden and CK-MB enzyme elevation after coronary interventions : intravascular ultrasound study of 2256 patients. Circulation. 2000;101:604–10.

    Article  CAS  PubMed  Google Scholar 

  23. Ricciardi MJ, Wu E, Davidson CJ, Choi KM, Klocke FJ, Bonow RO, Judd RM, Kim RJ. Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation. 2001;103:2780–3.

    Article  CAS  PubMed  Google Scholar 

  24. Choi JW, Gibson CM, Murphy SA, Davidson CJ, Kim RJ, Ricciardi MJ. Myonecrosis following stent placement: association between impaired TIMI myocardial perfusion grade and MRI visualization of microinfarction. Catheter Cardiovasc Interv. 2004;61:472–6.

    Article  PubMed  Google Scholar 

  25. Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Di Sciascio G; ARMYDA investigators. Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (atorvastatin for reduction of MYocardial damage during angioplasty) study. Circulation. 2004;110:674–678.

  26. Briguori C, Colombo A, Airoldi F, Violante A, Focaccio A, Balestrieri P, Paolo Elia P, Golia B, Lepore S, Riviezzo G, Scarpato P, Librera M, Bonizzoni E, Ricciardelli B. Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction. Eur Heart J. 2004;25:1822–8.

    Article  CAS  PubMed  Google Scholar 

  27. Chen WH, Lee PY, Ng W, Tse HF, Lau CP. Aspirin resistance is associated with a high incidence of myonecrosis after non-urgent percutaneous coronary intervention despite clopidogrel pretreatment. J Am Coll Cardiol. 2004;43:1122–6.

    Article  CAS  PubMed  Google Scholar 

  28. ten Berg JM, Kelder JC, Suttorp MJ, Mast EG, Bal E, Ernst SM, Verheugt FW, Plokker HW. Effect of coumarins started before coronary angioplasty on acute complications and long-term follow-up: a randomized trial. Circulation. 2000;102:386–91.

    Article  PubMed  Google Scholar 

  29. Grygier M, Araszkiewicz A, Lesiak M, Grajek S. Role of adenosine as an adjunct therapy in the prevention and treatment of no-reflow phenomenon in acute myocardial infarction with ST segment elevation: review of the current data. Kardiol Pol. 2013;71:115–20.

    Article  PubMed  Google Scholar 

  30. Navarese EP, Buffon A, Andreotti F, Gurbel PA, Kozinski M, Kubica A, Musumeci G, Cremonesi A, Tavazzi L, Kubica J, Castriota F. Adenosine improves post-procedural coronary flow but not clinical outcomes in patients with acute coronary syndrome: a meta-analysis of randomized trials. Atherosclerosis. 2012;222:1–7.

    Article  CAS  PubMed  Google Scholar 

  31. Sanati HR, Ghanavati R, Zahedmehr A, Shakerian F, Bakhshandeh H, Firouzi A, Kiani R. Intracoronary adenosine to prevent myonecrosis in patients with stable angina undergoing percutaneous interventions: a double-blinded randomized controlled trial. J Tehran Heart Cent. 2013;8:28–34.

    PubMed Central  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey

    Filiz Kizilirmak, Haci Murat Gunes, Gultekin Gunhan Demir, Tayyar Gokdeniz, Ekrem Guler, Beytullah Cakal, Mehmet Onur Omaygenç, Umeyir Savur & Irfan Barutcu

  2. Kartal Kosuyolu Research and Education Hospital, Istanbul University, Istanbul, Turkey

    Fatih Yılmaz

Authors
  1. Filiz Kizilirmak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haci Murat Gunes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gultekin Gunhan Demir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tayyar Gokdeniz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ekrem Guler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Beytullah Cakal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mehmet Onur Omaygenç
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fatih Yılmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Umeyir Savur
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Irfan Barutcu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Filiz Kizilirmak.

Ethics declarations

Funding

This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflict of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of paper.

Disclosures

The Authors declare that there is no conflict of interest.

Additional information

The study was conducted in Cardiology Department of Medipol University Hospital.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kizilirmak, F., Gunes, H.M., Demir, G.G. et al. Impact of Intracoronary Adenosine on Myonecrosis in Patients with Unstable Angina Pectoris Undergoing Percutaneous Coronary Intervention. Cardiovasc Drugs Ther 29, 519–526 (2015). https://doi.org/10.1007/s10557-015-6631-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10557-015-6631-4

Keywords

Search

Navigation