Retracted: intracoronary adenosine versus intravenous adenosine during primary PCI for ST-elevation myocardial infarction: which one offers better outcomes in terms of microvascular obstruction?

Abstract

Aims . Previous studies have suggested that intravenous administration of adenosine improves myocardial reperfusion and reduces infarct size in ST-elevation myocardial infarction (STEMI) patients. Intracoronary administration of adenosine has shown conflicting results. Methods . In this retrospective, single-centre, blinded clinical study, we assessed whether selective intracoronary administration of adenosine distal to the occlusion site immediately before initial balloon inflation reduces microvascular obstruction (MVO) as assessed with cardiac magnetic resonance imaging (MRI). Using contrast-enhanced sequences, microvascular obstruction (MVO) was calculated. We found 81 patients presenting with STEMI within 12h from symptom onset who were eligible for the study. In 80/81 (100%) patients receiving the study drug, MRI was performed on Day 1 after primary angioplasty. Results . The prevalence of MVO was reduced in the patients treated with intracoronary adenosine, (45%) comparedto85%ofpatientswhowereadministeredintravenousadenosine( 𝑃 = 0.0043 ).WefoundthatthesizeofMVOinpatients receiving intracoronary adenosine was significantly reduced compared to 0.91g in the intravenous-treated group ( 𝑃 = 0.027 ). There was no statistically significant difference in TIMI flow and clinical outcomes after primary PCI. Conclusion . We found significant evidence that selective high-dose intracoronary administration of adenosine distal to the occlusion site of the culprit lesion in STEMI patients results in a decrease in microvascular obstruction.