Salvage: Postconditioning With Adenosine for STEMI

• Beneficial Effect of Intracoronary Adenosine on Microvascular and Myocardial Salvage in Patients With Acute Myocardial Infarction
  
• By means of:
  
• 1. MR imaging
  
• - at day 2-3: Rest perfusion, MVO, late enhancement and function
  
• - at 4 months: Rest perfusion, late enhancement and function
  
• 2. Tissue Doppler Imaging
  
• At 16-36 hours: Resolution of edema/wall thickness increase Function
  
• At 4 months
  
• 3 Quantitative Coronary Angiography
  
• TIMI flow grade, TIMI frame count on angiography of the IRA and myocardial blush grade before and at completion of the primary PCI procedure will be performed.
  
• 4 Electrocardiographic Analysis
  
• - ST segment resolution will be assessed from the 12–lead ECG on admission and the ECG on admission on C.C.U. after the PCI–procedure. This will be examined for summed ST deviation and for ST deviation in the single lead with maximal ST–deviation on
  
• Finally, the last ECG before hospital discharge and an ECG at 4 months will be studied for the evolution of Q-waves and T-waves.
  
• - 24 hour continuous ST-segment recording in the single lead with maximal ST-deviation on admission with calculation of the area under the curve.
  
• 5 Echocardiographic evaluation of left ventricular function
  
• At 16-36 hours
  
• After 4 months
  
• 6 Cardiac markers
  
• Blood samples for determination of the MB fraction of creatinekinase and of troponin I are to be taken:
  
• On admission
  
• Before and after PCI, through the sheath
  
• At 90 minutes after PCI
  
• At 8 hours after PCI
  
• At 16 hours after PCI
  
• At 24 hours after PCI
  
• 7 Clinical follow-up
  
• Occurrence of MACE (death, new Q-wave or non Q-wave MI or target vessel revascularisation) and the presence of clinical signs of heart failure will be recorded
  
• At hospital discharge
  
• At 30 days
  
• At 6 months
  

Prospective, single center, randomized clinical study. Study design is random patient assignment to selective intracoronary administration of adenosine or control immediately before restoration of coronary artery patency in patients presenting with an acute ST segment-elevation myocardial infarction (STEMI). Randomisation will be stratified for the duration of symptoms (< 4 hours vs > 4 hours).