Effect of Adenosine on Myocardial Ischemia During Stent Angioplasty

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Effect of Adenosine on Myocardial Ischemia During
Stent Angioplasty

• Dr. MH Namazi
• Dr. J Mikaeili

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Introduction

• Increased QT dispersion (QTD) has been proposed
  as a surface ECG marker of transient myocardial
  ischemia and vulnerability to cardiac events.
• Adenosine, as an endogenous cardioprotective
  substance, has a crucial role in ischemic
  preconditioning.
• This study examines whether intracoronary
  adenosine infusion prior to balloon angioplasty
  affects transient myocardial ischemia.

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Adenosine effect
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Previous studies

• Billinger et al 1999
• Heidland et al 2000
• Kerensky et al 1995

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Objectives

• Comparison of
• ECG parameter (QTD)
• CK-MB
• No-reflow phenomenon
• Among adenosine and control groups

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Materials and Methods

• Randomized double-blind clinical trial,
• Nfifteen consecutive patients (9 male, 6 female)
  with significant stenosis at proximal LAD were
  selected and divided randomly into 2 groups
• The ischemic preconditioning group (n6)
• the adenosine preconditioning group (n9).

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• 12 lead electrocardiograms were obtained before
  intracoronary infusion, after infusion and during
  the last 30 seconds of each balloon inflation.
• QT interval measured by computer magnified
  tracing in all 12 leads and corrected for heart
  rate (QTc) by use of Bazetts formula.

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Stent types
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Chest pain distribution
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Mean CKMB in patients
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Comparison of basal and post inflation QTds
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Clinical Status
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Blood pressure and heart rate
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Complications

• Only one of the patients in the control group had
  no-reflow phenomenon and coronary dissection, who
  undewent successful stenting.
• There wasnt any no-reflow phenomenon among
  cases.

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Conclusion

• Pretreatment with adenosine can be effective for
  prophylactic use to attenuate ischemia in
  selected patients undergoing PTCA on LAD.