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J Am Coll Cardiol, 1999; 34:1711-1720 © 1999 by the American College of Cardiology Foundation |
|| ¶ # || ¶ # || ¶ # || ¶ # || ¶ #
a Duke Clinical Research Institute, Durham, North Carolina, USA
* Favaloro Foundation, Buenos Aires, Argentina
Harper Hospital, Detroit, Michigan, USA
University of Louisville, Louisville, Kentucky, USA
The Watson Clinic, Lakeland, Florida, USA
|| Washington University, St. Louis, Missouri, USA
¶ Medco Research, Inc., Research Triangle Park, North Carolina, USA
# The Mayo Clinic, Rochester, Minnesota, USA
Manuscript received September 17, 1998; revised manuscript received June 17, 1999, accepted August 12, 1999.
Reprint requests and correspondence: Dr. Kenneth W. Mahaffey, Duke Clinical Research Institute, PO Box 17969, Durham, North Carolina 27715
mahaf002{at}mc.duke.edu
OBJECTIVES
The Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial was designed to test the hypothesis that adenosine as an adjunct to thrombolysis would reduce myocardial infarct size.
BACKGROUND
Reperfusion therapy for acute myocardial infarction (MI) has been shown to reduce mortality, but reperfusion itself also may have deleterious effects.
METHODS
The AMISTAD trial was a prospective, open-label trial of thrombolysis with randomization to adenosine or placebo in 236 patients within 6 h of infarction onset. The primary end point was infarct size as determined by Tc-99 m sestamibi single-photon emission computed tomography (SPECT) imaging 6 ± 1 days after enrollment based on multivariable regression modeling to adjust for covariates. Secondary end points were myocardial salvage index and a composite of in-hospital clinical outcomes (death, reinfarction, shock, congestive heart failure or stroke).
RESULTS
In all, 236 patients were enrolled. Final infarct size was assessed in 197 (83%) patients. There was a 33% relative reduction in infarct size (p = 0.03) with adenosine. There was a 67% relative reduction in infarct size in patients with anterior infarction (15% in the adenosine group vs. 45.5% in the placebo group) but no reduction in patients with infarcts located elsewhere (11.5% for both groups). Patients randomized to adenosine tended to reach the composite clinical end point more often than those assigned to placebo (22% vs. 16%; odds ratio, 1.43; 95% confidence interval, 0.71 to 2.89).
CONCLUSIONS
Many agents thought to attenuate reperfusion injury have been unsuccessful in clinical investigation. In this study, adenosine resulted in a significant reduction in infarct size. These data support the need for a large clinical outcome trial.
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