ACADESINE - A NEW DRUG THAT MAY IMPROVE MYOCARDIAL PROTECTION IN CORONARY-ARTERY BYPASS-GRAFTING - RESULTS OF THE FIRST INTERNATIONAL MULTICENTER STUDY

The effect of acadesine, an adenosine-regulating agent, on the inciden ce of myocardial infarction, all adverse cardiovascular outcomes (myoc ardial infarction, cardiac death, left ventricular dysfunction, life-t hreatening arrhythmia, or cerebrovascular accident) and mortality was assessed in 821 patients undergoing coronary artery bypass grafting, P atients were prospectively stratified to a high-risk group (age > 70 y ears, unstable angina, previous coronary bypass, unsuccessful angiopla sty, or ejection fraction < 30%) or a non-high-risk group, They were r andomized in a doable-blind manner to placebo (n = 418) or acadesine ( n = 403) by intravenous infusion over 7 hours (0.1 mg/kg per minute) a nd in the cardioplegic solution (placebo or acadesine; 5 mu g/ml). Aca desine did not significantly affect the incidence of myocardial infarc tion in the overall study population, but it significantly reduced the incidence of Q-wave myocardial infarction in high-risk patients (plac ebo, 19.7%; acadesine, 10.0%; p = 0.032), The incidences of all advers e cardiovascular outcomes (placebo, 19.4%; acadesine, 18.4%) and overa ll mortality (placebo, 3.4%; acadesine, 2.7%) were similar between the two treatment groups, However, acadesine reduced the incidence of car diac related events that contributed to deaths occurring during the fi rst 3 postoperative days so that the incidence of death in this period was lower (placebo, 1.9%; acadesine, 0.2%; p = 0.038), No adverse eve nts were related to acadesine treatment, Although overall there were n o statistically significant between-group differences for the primary study end points, a secondary analysis in a prospectively defined high -risk subgroup suggests that acadesine may be beneficial in some patie nts.