role of adenosine in acute myocardial infarction.pptVIP

Role of Adenosine in Acute Myocardial Infarction Presented by: Mervyn B. Forman, MD, PhD, FACC Potential Sequelae of Reperfusion on Ischemic Myocardium Reperfusion Injury Conversion of reversibly injured endothelial and myocardial cells to irreversibly injured cells Myocardial Stunning Prolonged left ventricular dysfunction of reversibly injured myocytes Reperfusion Arrhythmias Myocardial Reperfusion Injury Definition: Conversion of reversibly injured endothelial and myocardial cells to irreversibly injured cells during the peri-reperfusion period. Not synonymous with entity of acceleration of necrosis of cells that are already irreversibly injured. Vascular Changes with Reperfusion Adenosine Receptors: SignalTransduction Mechanisms Effects of Adenosine A1 Effects of Adenosine A2A/A2B Effects of Adenosine A3 Mechanisms of Myocardial Reperfusion Injury and Effects of Adenosine Infarct Size with Intracoronary Adenosine Effect of IV Adenosine Transverse Myocardial Slice in Adenosine and Control Animal Regional Ventricular Function in Ischemic Zone Significant improvement noted at 3 and 72 hours after reperfusion. IC Adenosine with PCI in AMI Final Infarct Size (as a Percentage of the Left Ventricle) AMISTAD II Anterior Wall MI (STE, LBBB) ?6h No contraindication for lysis No hypotension No bradycardia No obstructive airway disease AMISTAD II – Non MACE Adverse Events AMISTAD II Infarct Size 57% reduction in median infarct size with 70mcg/kg/min group relative to placebo AMISTAD II- Post Hoc Analysis  Effect of early reperfusion treatment (3.1 hrs) on clinical outcomes Effect of Adenosine with Varying Duration of Ischemia Overall Survival Curves Key Points Adenosine shown consistently to reduce infarct size 70mcg/kg/min infusion for 3 hours shows 57% relative reduction in infarct size Strong trend toward less death and CHF Significant reduction in death and composite endpoint at 6 months in Adenosine group treated early (~3.1 hrs) -post hoc ana