Intracoronary adenosine administered during aortocoronary vein graft interventions may reduce the incidence of no-reflow phenomenon. A pilot randomised trial.

BACKGROUND The results of percutaneous coronary intervention (PCI) for saphenous vein graft (SVG) disease are limited by distal embolisation and no-reflow which occurs in 10-43% of cases. AIM To examine the role of a new protocol of adenosine administration during PCI in SVG on immediate angiographic results and clinical course. METHODS A prospective, single-centre, randomised placebo-controlled pilot trial in 32 consecutive patients after coronary artery bypass graft (aged 71 ± 12 years, 22 male) with stable and unstable angina (CCS II-IV), who were admitted to our hospital for SVG PCI, was conducted. Patients were randomised to two groups. Group A (16 patients) received two times adenosine (2 mg + 2 mg) to the SVG during PCI procedure, and Group B (16 patients) received a placebo. RESULTS No reflow was observed in one (6.25%) patient in the adenosine group and six (37.5%) patients in the placebo group (p = 0.0325). TIMI 3 flow (94% vs. 63%; p = 0.0322) and corrected TIMI frame count < 28 (94% vs. 63%; p = 0.0322) at the end of the procedure were better in patients who received adenosine. Myocardial blush grade 2 and 3 at the end of th eprocedure was observed in 15 patients in the adenosine group and ten patients in the placebo group (p = 0.083). A trend toward a lower rate of myocardial infarctions in the adenosine group was observed (6% vs. 25%; p = 0.144). CONCLUSIONS Adenosine injections may be effective in preventing no-reflow in the setting of PCI of SVG. Adenosine administration seems to be associated with a more favourable clinical course.