{"title":"腺苷作为接受原发性经皮冠状动脉介入治疗的急性心肌梗死的辅助疗法：随机对照试验的系统回顾和元分析》。","authors":"Xue-Mei Feng, Wen-Hui Zhang, Jia Liu","doi":"10.31083/RCM24065","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Adenosine administration can improve coronary blood flow in patients undergoing primary percutaneous coronary intervention (PCI); however, the therapeutic effects of adenosine on ST resolution and major adverse cardiovascular events (MACEs) after PCI remain unclear. This study aimed to assess the therapeutic effects of adjunctive adenosine administration on patients with acute myocardial infarction (AMI) undergoing PCI using a meta-analytic approach.</p><p><strong>Methods: </strong>We conducted a systematic search across PubMed, Embase, and the Cochrane Library to identify eligible randomized controlled trials (RCTs) published from inception through to March 2024. Primary outcomes included ST resolution and MACEs. The pooled analyses were all conducted using the random-effects model. Additionally, exploratory analyses were carried out through the application of sensitivity and subgroup analyses.</p><p><strong>Results: </strong>Twenty-one RCTs involving 2467 patients with AMI were selected for the meta-analysis. Adenosine significantly increased the incidence of ST resolution (relative risk [RR]: 1.30; 95% confidence interval [CI]: 1.15-1.46; <i>p</i> < 0.001), while it significantly reduced the risk of MACEs (RR: 0.67; 95% CI: 0.51-0.87; <i>p</i> = 0.003). Moreover, the use of adenosine was associated with reduced incidences of no reflow (RR: 0.35; 95% CI: 0.24-0.52; <i>p</i> < 0.001) and myocardial blush grade (MBG) 0 to 1 (RR: 0.75; 95% CI: 0.58-0.99; <i>p</i> = 0.041). Furthermore, adenosine significantly reduced the risk of heart failure (RR: 0.66; 95% CI: 0.44-0.99; <i>p</i> = 0.044). Finally, adenosine use was associated with a lower creatine kinase-MB (CK-MB) peak value (weighted mean difference: -36.94; 95% CI: -73.76- -0.11; <i>p</i> = 0.049).</p><p><strong>Conclusions: </strong>This study revealed that adenosine use was associated with an increased incidence of ST resolution, and reduced risk of MACEs.</p><p><strong>The inplasy registration: </strong>INPLASY202510051, https://inplasy.com/inplasy-2025-1-0051/.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 2","pages":"24065"},"PeriodicalIF":1.9000,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868911/pdf/","citationCount":"0","resultStr":"{\"title\":\"Adenosine as an Adjunctive Therapy for Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.\",\"authors\":\"Xue-Mei Feng, Wen-Hui Zhang, Jia Liu\",\"doi\":\"10.31083/RCM24065\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Adenosine administration can improve coronary blood flow in patients undergoing primary percutaneous coronary intervention (PCI); however, the therapeutic effects of adenosine on ST resolution and major adverse cardiovascular events (MACEs) after PCI remain unclear. This study aimed to assess the therapeutic effects of adjunctive adenosine administration on patients with acute myocardial infarction (AMI) undergoing PCI using a meta-analytic approach.</p><p><strong>Methods: </strong>We conducted a systematic search across PubMed, Embase, and the Cochrane Library to identify eligible randomized controlled trials (RCTs) published from inception through to March 2024. Primary outcomes included ST resolution and MACEs. The pooled analyses were all conducted using the random-effects model. Additionally, exploratory analyses were carried out through the application of sensitivity and subgroup analyses.</p><p><strong>Results: </strong>Twenty-one RCTs involving 2467 patients with AMI were selected for the meta-analysis. Adenosine significantly increased the incidence of ST resolution (relative risk [RR]: 1.30; 95% confidence interval [CI]: 1.15-1.46; <i>p</i> < 0.001), while it significantly reduced the risk of MACEs (RR: 0.67; 95% CI: 0.51-0.87; <i>p</i> = 0.003). Moreover, the use of adenosine was associated with reduced incidences of no reflow (RR: 0.35; 95% CI: 0.24-0.52; <i>p</i> < 0.001) and myocardial blush grade (MBG) 0 to 1 (RR: 0.75; 95% CI: 0.58-0.99; <i>p</i> = 0.041). Furthermore, adenosine significantly reduced the risk of heart failure (RR: 0.66; 95% CI: 0.44-0.99; <i>p</i> = 0.044). Finally, adenosine use was associated with a lower creatine kinase-MB (CK-MB) peak value (weighted mean difference: -36.94; 95% CI: -73.76- -0.11; <i>p</i> = 0.049).</p><p><strong>Conclusions: </strong>This study revealed that adenosine use was associated with an increased incidence of ST resolution, and reduced risk of MACEs.</p><p><strong>The inplasy registration: </strong>INPLASY202510051, https://inplasy.com/inplasy-2025-1-0051/.</p>\",\"PeriodicalId\":20989,\"journal\":{\"name\":\"Reviews in cardiovascular medicine\",\"volume\":\"26 2\",\"pages\":\"24065\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-02-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868911/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Reviews in cardiovascular medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.31083/RCM24065\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reviews in cardiovascular medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.31083/RCM24065","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Adenosine as an Adjunctive Therapy for Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Background: Adenosine administration can improve coronary blood flow in patients undergoing primary percutaneous coronary intervention (PCI); however, the therapeutic effects of adenosine on ST resolution and major adverse cardiovascular events (MACEs) after PCI remain unclear. This study aimed to assess the therapeutic effects of adjunctive adenosine administration on patients with acute myocardial infarction (AMI) undergoing PCI using a meta-analytic approach.
Methods: We conducted a systematic search across PubMed, Embase, and the Cochrane Library to identify eligible randomized controlled trials (RCTs) published from inception through to March 2024. Primary outcomes included ST resolution and MACEs. The pooled analyses were all conducted using the random-effects model. Additionally, exploratory analyses were carried out through the application of sensitivity and subgroup analyses.
Results: Twenty-one RCTs involving 2467 patients with AMI were selected for the meta-analysis. Adenosine significantly increased the incidence of ST resolution (relative risk [RR]: 1.30; 95% confidence interval [CI]: 1.15-1.46; p < 0.001), while it significantly reduced the risk of MACEs (RR: 0.67; 95% CI: 0.51-0.87; p = 0.003). Moreover, the use of adenosine was associated with reduced incidences of no reflow (RR: 0.35; 95% CI: 0.24-0.52; p < 0.001) and myocardial blush grade (MBG) 0 to 1 (RR: 0.75; 95% CI: 0.58-0.99; p = 0.041). Furthermore, adenosine significantly reduced the risk of heart failure (RR: 0.66; 95% CI: 0.44-0.99; p = 0.044). Finally, adenosine use was associated with a lower creatine kinase-MB (CK-MB) peak value (weighted mean difference: -36.94; 95% CI: -73.76- -0.11; p = 0.049).
Conclusions: This study revealed that adenosine use was associated with an increased incidence of ST resolution, and reduced risk of MACEs.
The inplasy registration: INPLASY202510051, https://inplasy.com/inplasy-2025-1-0051/.
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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