A Randomized, Double-Blinded, Placebo-Controlled Multicenter Trial of Adenosine as an Adjunct to Reperfusion in the Treatment of Acute Myocardial Infarction (AMISTAD-II)
| Autor: | R. Wayne Alexander, Gregg W. Stone, Allan M. Ross, Robert A. Kloner, Raymond J. Gibbons |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
medicine.medical_specialty
Adenosine Randomization Heart disease Double blinded Vasodilator Agents Myocardial Infarction Placebo Double-Blind Method Internal medicine Multicenter trial medicine Humans Thrombolytic Therapy cardiovascular diseases Myocardial infarction Angioplasty Balloon Coronary Heart Failure Dose-Response Relationship Drug business.industry medicine.disease Hospitalization surgical procedures operative Circulatory system cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of the American College of Cardiology. 45:1775-1780 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2005.02.061 |
| Popis: | ObjectivesThe purpose of this research was to determine the effect of intravenous adenosine on clinical outcomes and infarct size in ST-segment elevation myocardial infarction (STEMI) patients undergoing reperfusion therapy.BackgroundPrevious small studies suggest that adenosine may reduce the size of an evolving infarction.MethodsPatients (n = 2,118) with evolving anterior STEMI receiving thrombolysis or primary angioplasty were randomized to a 3-h infusion of either adenosine 50 or 70 μg/kg/min or of placebo. The primary end point was new congestive heart failure (CHF) beginning >24 h after randomization, or the first re-hospitalization for CHF, or death from any cause within six months. Infarct size was measured in a subset of 243 patients by technetium-99m sestamibi tomography.ResultsThere was no difference in the primary end point between placebo (17.9%) and either the pooled adenosine dose groups (16.3%) or, separately, the 50-μg/kg/min dose and 70-μg/kg/min groups (16.5% vs. 16.1%, respectively, p = 0.43). The pooled adenosine group trended toward a smaller median infarct size compared with the placebo group, 17% versus 27% (p = 0.074). A dose-response relationship with final median infarct size was seen: 11% at the high dose (p = 0.023 vs. placebo) and 23% at the low dose (p = NS vs. placebo). Infarct size and occurrence of a primary end point were significantly related (p < 0.001).ConclusionsClinical outcomes in patients with STEMI undergoing reperfusion therapy were not significantly improved with adenosine, although infarct size was reduced with the 70-μg/kg/min adenosine infusion, a finding that correlated with fewer adverse clinical events. A larger study limited to the 70-μg/kg/min dose is, therefore, warranted. |
| Databáze: | OpenAIRE |
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