Abstrakt:
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.
