Does adenosine prevent myocardial micronecrosis following percutaneous coronary intervention? The ADELINE pilot trial

After successful percutaneous coronary intervention (PCI), 24–44% of patients suffer some myocardial damage as indicated by a significant change in the concentrations of cardiospecific troponin or the MB isoenzyme of creatine kinase (CK-MB).1,2 Patients with minor increases of these cardiac markers after PCI constitute a population with a worse long term prognosis.3 Preconditioning of human myocardium can be obtained by intracoronary administration of adenosine, as indicated by attenuation of ischaemia and chest pain in patients undergoing PCI.4 In the present trial (ADELINE, does ADEnosine Limit myocardial Necrosis), we investigated the effect of intracoronary administration on chest pain and ischaemia during a 90 second balloon inflation during PCI. In addition, we evaluated the release of cardiac markers after angiographically successful coronary intervention. Patients were eligible when a PCI was planned of a lesion in a primary or secondary branch of either coronary artery, supplying a sizeable area of myocardium. Exclusion criteria were: myocardial infarction during the previous two weeks; use of theophylline preparations, dipyridamole or glibenclamide; bronchial asthma; second or third degree atrioventricular block, and recanalisation of a total occlusion. This study was approved by the institutional review board, and written informed consent was obtained from all patients. In this single centre, single blind study, 32 patients were randomly allocated to a control or an adenosine treated group. One patient was excluded because of occlusion of a major branch during PCI, and three patients were excluded because …