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Background and Purpose: Pre- and post-conditioning by transient episodes of ischemia render the myocardium more resistant to subsequent ischemia, a phenomenon known as ischemic pre-conditioning. This effect is thought to be partly mediated by endogenous adenosine. The aim of the study was to investigate the efficacy and safety of intracoronary adenosine on myocardial perfusion in patients schedule for elective percutaneous coronary intervention. Methods: A prospective observational comparative study of 120 patients with coronary artery disease scheduled for elective percutaneous coronary intervention. Patients were randomly to receive intracoronary adenosine (n = 60 ) or placebo (n= 60), both groups were compared regarding clinical risk factors electrocardiographic, echocardiographic, cardiac troponin ,C-reactive protein, angiographic variables and major adverse cardiac events. Results: Among clinical risk factors, smoking and obesity were significantly higher in placebo group. ECG data, echocardiographic data, Troponin data and myonecrosis were not statistically significant different between both groups before and after percutaneous coronary intervention, but high sensitive C-reactive protein was statistically significantly higher post percutaneous coronary intervention in placebo group. There was no statistically significant difference between both groups regarding percutaneous coronary intervention results, periprocedural complications and short term clinical outcome. Conclusion: Myocardial preconditioning by intracoronary adenosine in patients schedule for elective percutaneous coronary intervention is safe but did not provide any benefit in terms of decreasing periprocedural myonecrosis or improving short term clinical outcome. The elevation of high sensitive C-reactive protein is determined by more vessels manipulation by more pre dilation , post dilatation and more number of stents.

Myocardial Preconditioning by Intracoronary Adenosine before Elective Percutaneous Coronary Intervention (short term outcome)