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Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial.

Publication ,  Journal Article
Mahaffey, KW; Puma, JA; Barbagelata, NA; DiCarli, MF; Leesar, MA; Browne, KF; Eisenberg, PR; Bolli, R; Casas, AC; Molina-Viamonte, V ...
Published in: J Am Coll Cardiol
November 15, 1999

OBJECTIVES: The Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial was designed to test the hypothesis that adenosine as an adjunct to thrombolysis would reduce myocardial infarct size. BACKGROUND: Reperfusion therapy for acute myocardial infarction (MI) has been shown to reduce mortality, but reperfusion itself also may have deleterious effects. METHODS: The AMISTAD trial was a prospective, open-label trial of thrombolysis with randomization to adenosine or placebo in 236 patients within 6 h of infarction onset. The primary end point was infarct size as determined by Tc-99 m sestamibi single-photon emission computed tomography (SPECT) imaging 6+/-1 days after enrollment based on multivariable regression modeling to adjust for covariates. Secondary end points were myocardial salvage index and a composite of in-hospital clinical outcomes (death, reinfarction, shock, congestive heart failure or stroke). RESULTS: In all, 236 patients were enrolled. Final infarct size was assessed in 197 (83%) patients. There was a 33% relative reduction in infarct size (p = 0.03) with adenosine. There was a 67% relative reduction in infarct size in patients with anterior infarction (15% in the adenosine group vs. 45.5% in the placebo group) but no reduction in patients with infarcts located elsewhere (11.5% for both groups). Patients randomized to adenosine tended to reach the composite clinical end point more often than those assigned to placebo (22% vs. 16%; odds ratio, 1.43; 95% confidence interval, 0.71 to 2.89). CONCLUSIONS: Many agents thought to attenuate reperfusion injury have been unsuccessful in clinical investigation. In this study, adenosine resulted in a significant reduction in infarct size. These data support the need for a large clinical outcome trial.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

November 15, 1999

Volume

34

Issue

6

Start / End Page

1711 / 1720

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Treatment Outcome
  • Tomography, Emission-Computed, Single-Photon
  • Thrombolytic Therapy
  • Radiography
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
 

Citation

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Mahaffey, K. W., Puma, J. A., Barbagelata, N. A., DiCarli, M. F., Leesar, M. A., Browne, K. F., … Granger, C. B. (1999). Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial. J Am Coll Cardiol, 34(6), 1711–1720. https://doi.org/10.1016/s0735-1097(99)00418-0
Mahaffey, K. W., J. A. Puma, N. A. Barbagelata, M. F. DiCarli, M. A. Leesar, K. F. Browne, P. R. Eisenberg, et al. “Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial.J Am Coll Cardiol 34, no. 6 (November 15, 1999): 1711–20. https://doi.org/10.1016/s0735-1097(99)00418-0.
Mahaffey KW, Puma JA, Barbagelata NA, DiCarli MF, Leesar MA, Browne KF, Eisenberg PR, Bolli R, Casas AC, Molina-Viamonte V, Orlandi C, Blevins R, Gibbons RJ, Califf RM, Granger CB. Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial. J Am Coll Cardiol. 1999 Nov 15;34(6):1711–1720.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

November 15, 1999

Volume

34

Issue

6

Start / End Page

1711 / 1720

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Treatment Outcome
  • Tomography, Emission-Computed, Single-Photon
  • Thrombolytic Therapy
  • Radiography
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans