Adenosine myocardial protection: preliminary results of a phase II clinical trial.

Published

Journal Article

OBJECTIVE:To evaluate the safety, tolerance, and efficacy of adenosine in patients undergoing coronary artery bypass surgery. SUMMARY BACKGROUND DATA:Inadequate myocardial protection in patients undergoing coronary artery bypass surgery contributes to overall hospital morbidity and mortality. For this reason, new pharmacologic agents are under investigation to protect the regionally and globally ischemic heart. METHODS:In a double-blind, placebo-controlled trial, 253 patients were randomized to one of three cohorts. The treatment arms consisted of the intraoperative administration of cold blood cardioplegia, blood cardioplegia containing 500 microM adenosine, and blood cardioplegia containing 2 mM adenosine. Patients receiving adenosine cardioplegia were also given an infusion of adenosine (200 microg/kg/min) 10 minutes before and 15 minutes after removal of the aortic crossclamp. Invasive and noninvasive measurements of ventricular performance were obtained before, during, and after surgery. RESULTS:The high-dose adenosine cohort was associated with a trend toward a decrease in high-dose dopamine support and a lower incidence of myocardial infarction. A composite outcome analysis demonstrated that patients who received high-dose adenosine were less likely to experience one of five adverse events: high-dose dopamine use, epinephrine use, insertion of intraaortic balloon pump, myocardial infarction, or death. The operative mortality rate for all patients studied was 3.6% (9/253). CONCLUSIONS:Adenosine treatment is safe and well tolerated and may be associated with fewer postoperative complications.

Full Text

Cited Authors

  • Mentzer, RM; Birjiniuk, V; Khuri, S; Lowe, JE; Rahko, PS; Weisel, RD; Wellons, HA; Barker, ML; Lasley, RD

Published Date

  • May 1999

Published In

Volume / Issue

  • 229 / 5

Start / End Page

  • 643 - 649

PubMed ID

  • 10235522

Pubmed Central ID

  • 10235522

Electronic International Standard Serial Number (EISSN)

  • 1528-1140

International Standard Serial Number (ISSN)

  • 0003-4932

Digital Object Identifier (DOI)

  • 10.1097/00000658-199905000-00006

Language

  • eng