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

作者：Navarese Eliano Pio^*; Buffon Antonino; Andreotti Felicita; Gurbel Paul Alfred; Kozinski Marek; Kubica Aldona; Musumeci Giuseppe; Cremonesi Alberto; Tavazzi Luigi; Kubica Jacek; Castriota Fausto

来源：Atherosclerosis, 2012, 222(1): 1-7.

DOI：10.1016/j.atherosclerosis.2011.11.001

• Adenosine
• Acute coronary syndrome
• Clinical outcome

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. %26lt;br%26gt;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 %26gt;50% ST-resolution. %26lt;br%26gt;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. %26lt;br%26gt;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.

• 出版日期2012-5