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

2011; Elsevier BV; Volume: 222; Issue: 1 Linguagem: Inglês

10.1016/j.atherosclerosis.2011.11.001

1879-1484

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

Coronary Interventions and Diagnostics

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 (ORFixed [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.