| BackgroundIn the ischemic myocardium, reperfusion is necessary for thesalvage of cells and cardiac function. However, reperfusion itselfcauses reperfusion injury, leading to the damage of myocardialcells. The benefits of vessel recanalization in acute myocardialinfarction (AMI) are impaired by reperfusion injury. a clinicalconsequence of reperfusion injury may result in microvasculardamage, no-reflow phenomenon, myocardial stunning,hibernation and arrhythmias. Adenosine has been studiedextensively as a cardioprotective agent. It has been shown toreplenish high-energy phosphate stores in endothelial cells andmyocytes, to inhibit oxygen free radial formation, to inhibitneutrophil activity and accumulation and to improvemicrovascular function. Adenosine has been shown to protectischemic-reperfusion myocardium from animal studies in thecountry and out the country. In the animols model of reperfusioninjury, Adenosine is able to reduce the infarct size, improve leftventricular (LV) systolic function, increase coronary blood flow.some clinical trials, in patients with acute MI, treatment withadenosine has been conducted: the final infarct size and incidenceof no-reflow phenomenon were reduced, and trends towardsimproved survival were observed in patients with anterior ·5·MI.However, at present, few clinical trials that related toprotective effects of Adenosine on myocardial reperfusion injuryafter percutaneous coronary intervention (PCI) in patients withacute myocardial infarction were reported. Objective The aim of this study was to observe protective effects ofadenosine on myocardial reperfusion injury after percutaneouscoronary intervention (PCI) in patients with acute myocardialinfarction (AMI). Methods Forty AMI patients who received PCI were randomly dividedinto two groups-the Adenosi ne group (n=20) and the saline group.The two groups were similar for age, sex, risk factor and infarctlocation, et al. After left and right coronary arteriography by the femoralapproach, infarct-related artery was ascertained. The positioningof obstruction of the infarct-related artery was exposed clearly byadopting perfect posture, then the balloon was inflated andstenting of the dilated coronary segment was performed. PCI wassuccessful in all patients. After coronary artery recanalization,two groups were immediately given to the adenosine (240μg) orsaline (10ml) by intracoronary injection. Before PCI and 30minafter PCI, serum levels of malondialdehyde (MDA), superoxidedismutase (SOD) in patients' coronary artery blood, and serumlevels of peak of CK-MB in vein blood were measured, andcoronary flow was assessed by the method of frame counting atthe moment of coronary artery recanalization and 5min afterinjecting medicine. Results: As compared with before operation in the two group, MDAwas higher and SOD was lower at 30min after operation (P<0.05);levels of MDA, SOD in the two group before operation weresimilar, there is not significant difference. Comparison betweenthe two groups showed significant difference in levels of MDAand SOD at 30min after operation: increasing range of MDA inthe group with adenosine was fewer than that of in the salinegroup (P<0.05), and decreasing range of SOD in the group withadenosine was also fewer than that of the saline group (P<0.05).levels of peak of CK-MB in the group with adenosine was lowerthan that in the group with saline, and there is significantlydifferent. Frame countings of coronary flow in the two groups atthe moment of coronary artery recanalization was similar and notdifferent, but frame countings of coronary flow in the two groupsis more than that of normal. frame countings of coronary flow inthe group with adenosine was decreased at 5min after vesselrecanalization,which is significant compared with that of at themoment of coronary artery recanalization and the other group(P<0.05).Dicussion The finding of our study was that levels of peak of CK-MBin the group with adenosine was lower than that in the group withsaline, which showed intracoronary Adenosine infusion resultedin a significant alleviation in myocardium damage after ischemicmyocardium was reperfused, and reduction in leakage ofmyocardium kinase. MDA was higher and SOD was lower at 30min afteroperation (P<0.05) than that of before operation. After coronaryartery recanalization, frame countings of coronary flow in the twogroups is more than that of normal. which showed increasion ofproduction of oxygen free radicals, potentiation oflipoperoxidation action, and incidence of no-flow phenomenon.As comparised with saline group after operation, increasing rangeof MDA and decreasing range of SOD in the adenosine group wasfewer (P<0.05), frame countings of coronary flow in theadenosine group was fewer at 5min after vesselrecanalization (P<0.05), which showed adenosine can lessenreperfusion injury, and improve coronary blood flow andmicrocirculation and no-flow phenomenon. urthermore,adenosine doses of 240 ug for the patients is safe and endured,while In the beforehand trial, side effects is increased follwingadding of adenosine doses . Conclusion:... |
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