Cardioprotective effect of adenosine pretreatment in coronary artery bypass grafting

Objective: There are several reports of the use of adenosine as a cardiopro tective agent during cardiac surgery. Adenosine treatment might affect neut rophils and inflammatory mediators. The present prospective randomized stud y was designed to investigate the effect of adenosine pretreatment on myoca rdial recovery and inflammatory response in patients undergoing elective co ronary artery bypass surgery. Design: A prospective, randomized, controlled study. Setting: Operative unit and ICU in a university, hospital in Finland. Patients: Thirty male patients undergoing primary, elective coronary revasc ularization. Interventions: Patients in the adenosine group received a 7-min infusion of adenosine (total, 650 mug/kg) before the initiation of cardiopulmonary byp ass. Measurements: Postoperative creatine kinase (CK)-MB release and hemodynamic s were recorded. Perioperative leukocyte and cytokine release were measured . Results: Adenosine pretreatment resulted in less CK-MB release and an impro ved postbypass cardiac index. Similar leukocyte counts and cytokine respons es were seen in both groups perioperatively. Neutrophil counts were similar between the groups before and after myocardial ischemia when measured simu ltaneously in arterial and coronary sinus blood. Conclusions: The present results support the hypothesis that adenosine pret reatment is cardioprotective in humans, but the present dose failed to regu late the inflammatory responses after coronary artery bypass grafting.