Document Detail


Intravenous adenosine and lidocaine in patients with acute myocardial infarction.
MedLine Citation:
PMID:  9704679     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: A pilot study was designed to assess the safety of combined intravenous adenosine and lidocaine in patients with acute myocardial infarction and to estimate the likelihood of a beneficial effect on final infarct size.
BACKGROUND: Adenosine plus lidocaine reduces infarct size in animals, but the safety and efficacy in human beings is unknown.
METHODS AND RESULTS: Adenosine (70 microg/kg per minute intravenous infusion) plus lidocaine (1 mg/kg intravenous bolus injection and 2 mg/kg per minute infusion) was given to 45 patients with acute myocardial infarction. Patients underwent immediate balloon angioplasty without preceding thrombolytic therapy. Myocardial perfusion defects were measured with serial technetium 99m sestamibi studies. One patient developed persisting hypotension in conjunction with a large inferolateral myocardial infarction. Transient hypotension in three other patients resolved with a reduction in adenosine. Advanced atrioventricular block was never observed. Other adverse events (including atrial fibrillation, ventricular tachyarrhythmia, bradycardia, and respiratory distress) occurred at low frequencies, as expected for patients with acute myocardial infarction. An initial median perfusion defect of 45% of the left ventricle (60% for anterior infarction, 17% for nonanterior infarction) was observed. At hospital discharge (mean +/- SD = 4.3 +/- 2.1 days) the median value was 12%, and at 8 +/- 4 weeks it was 3% (7% for anterior infarction, 0% for nonanterior infarction); 14 patients had no measurable follow-up. Compared with historical control patients, prehospital discharge measurements were not different but late perfusion defects were improved.
CONCLUSIONS: Treatment with intravenous adenosine and lidocaine during acute myocardial infarction has sufficient safety and potential for improved myocardial salvage. Randomized studies are justified.
Authors:
K N Garratt; D R Holmes; V Molina-Viamonte; G S Reeder; D O Hodge; K R Bailey; J K Lobl; D A Laudon; R J Gibbons
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  136     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1998 Aug 
Date Detail:
Created Date:  1998-08-19     Completed Date:  1998-08-19     Revised Date:  2013-03-14    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  196-204     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn. 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adenosine / administration & dosage*,  adverse effects
Adult
Aged
Angioplasty, Balloon, Coronary
Anti-Arrhythmia Agents / administration & dosage*,  adverse effects
Combined Modality Therapy
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Electrocardiography / drug effects
Female
Hemodynamics / drug effects
Humans
Infusions, Intravenous
Lidocaine / administration & dosage*,  adverse effects
Male
Middle Aged
Myocardial Infarction / drug therapy*,  radionuclide imaging
Myocardial Reperfusion Injury / prevention & control,  radionuclide imaging
Pilot Projects
Technetium Tc 99m Sestamibi / diagnostic use
Tomography, Emission-Computed, Single-Photon
Treatment Outcome
Vasodilator Agents / administration & dosage*,  adverse effects
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Vasodilator Agents; 109581-73-9/Technetium Tc 99m Sestamibi; 137-58-6/Lidocaine; 58-61-7/Adenosine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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