Objective To evaluate the safety, tolerance, and efficacy of adenosine in p
atients undergoing coronary artery bypass surgery.
Summary Background Data Inadequate myocardial protection in patients underg
oing coronary artery bypass surgery contributes to overall hospital morbidi
ty and mortality. For this reason, new pharmacologic agents are under inves
tigation to protect the regionally and globally ischemic heart.
Methods In a double-blind, placebo-controlled trial, 253 patients were rand
omized to one of three cohorts. The treatment arms consisted of the intraop
erative administration of cold blood cardioplegia, blood cardioplegia conta
ining 500 mu M adenosine, and blood cardioplegia containing 2 mM adenosine.
Patients receiving adenosine cardioplegia were also given an infusion of a
denosine (200 mu g/kg/min) 10 minutes before and 15 minutes after removal o
f the aortic crossclamp. Invasive and noninvasive measurements of ventricul
ar performance were obtained before, during, and after surgery,
Results The high-dose adenosine cohort was associated with a trend toward a
decrease in high-dose dopamine support and a lower incidence of myocardial
infarction. A composite outcome analysis demonstrated that patients who re
ceived high-dose adenosine were less likely to experience one of five adver
se events: high-dose dopamine use, epinephrine use, insertion of intraaorti
c balloon pump, myocardial infarction, or death. The operative mortality ra
te for all patients studied was 3.6% (9/253).
Conclusions Adenosine treatment is safe and well tolerated and may be assoc
iated with fewer postoperative complications.