Effects of Age, Gender, Obesity, and Diabetes on the Efficacy and Safety of the Selective A2A Agonist Regadenoson Versus Adenosine in Myocardial Perfusion Imaging Integrated ADVANCE-MPI Trial Results
Effects of Age, Gender, Obesity, and Diabetes on the Efficacy and Safety of the Selective A2A Agonist Regadenoson Versus Adenosine in Myocardial Perfusion Imaging Integrated ADVANCE-MPI Trial Results
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DOI：
10.1016/j.jcmg.2008.02.003
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发表时间：
2008-05-01
影响因子：
14
通讯作者：
Iskandrian, Ami E.
中科院分区：
文献类型：
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作者：
Cerqueira, Manuel D.;Nguyen, Patricia;Iskandrian, Ami E.
目的比较年龄、性别、体重指数和糖尿病对瑞格腺苷负荷心肌灌注显像的安全性和有效性的影响，并评价瑞格腺苷在检测可逆性心肌灌注缺陷方面与腺苷的非劣性。背景以往的报道表明，用放射性核素显像检测可逆性心肌灌注缺损者，固定单位剂量的瑞格腺苷是安全且不劣于腺苷的。方法利用一个包含2015名患者的数据库，我们评估了年龄、性别、体重指数和糖尿病对瑞格腺苷与腺苷的安全性和有效性的影响。结果在检测相对于腺苷的缺血方面，所有患者都表现出非劣势(符合率差异为0%，95%CI-6.2%至+6.8%)。腺苷-腺苷和腺苷-瑞格腺苷的平均符合率分别为0.62+/-0.03和0.63+/-0.02。在特定的亚组中，缺血的检测也具有可比性。在中度和大面积缺血的女性和男性中，这两种药物的一致性较低。与腺苷相比，瑞格腺苷的综合症状评分较低，胸痛、潮红、咽喉、颈部或下巴疼痛较少，但头痛和胃肠道不适较多。几乎在所有分组中都是如此。瑞格腺苷患者报告感觉更舒适(1.7p/-0.02vs.1.9+/-0.03p<；0.001)。根据总体耐受性得分，女性在服用这两种压力剂时感觉比男性更不舒服。图像质量两种剂型的优良率均为92%。结论无论年龄、性别、体重指数和糖尿病，瑞格腺苷都可以安全地作为一个固定的单位给药，在检测缺血方面与腺苷一样有效。在整体和不同的亚组中，瑞格腺苷的耐受性更好。(J Am Coll Hearol IMG 2008；1：307-16)(C)2008，美国心脏病学会基金会
OBJECTIVES To compare the effects of age, gender, body mass index, and diabetes on the safety and efficacy of regadenoson stress myocardial perfusion imaging, and to assess the noninferiority of regadenoson to adenosine for the detection of reversible myocardial perfusion defects.BACKGROUND Previous reports have shown that a fixed unit bolus of regadenoson is safe and noninferior to adenosine for the detection of reversible perfusion defects by radionuclide imaging. METHODS Using a database of 2,015 patients, we evaluated the effects of age, gender, body mass index, and diabetes on the safety and efficacy of regadenoson compared to adenosine.RESULTS For detection of ischemia relative to adenosine, noninferiority was demonstrated for all patients (agreement rate difference 0%, 95% CI -6.2% to +6.8%). The average agreement rate between adenosine-adenosine and adenosine-regadenoson were 0.62 +/- 0.03 and 0.63 +/- 0.02. Detection of ischemia was also comparable in specific subgroups. Agreement was less for both agents in women versus men with moderate and large areas of ischemia. Compared to adenosine, regadenoson had a lower combined symptom score and less chest pain, flushing, and throat, neck, or jaw pain, but more headache and gastrointestinal discomfort. This was true in nearly all subgroups. Regadenoson patients reported feeling more comfortable (1.7 +/- .02 vs. 1.9 +/- 0.03, p < 0.001). Based on the overall tolerability score, women felt less comfortable than men with both stress agents. Image quality was rated good or excellent in 92% for both agents.CONCLUSIONS Regadenoson can be safely administered as a fixed unit bolus and is as efficacious as adenosine in detecting ischemia regardless of age, gender, body mass index, and diabetes. Regadenoson is better tolerated overall and across various subgroups. (J Am Coll Cardiol Img 2008; 1: 307-16) (C) 2008 by the American College of Cardiology Foundation