Effects of A1 adenosine receptor blockade by bamiphylline on ischaemic preconditioning during coronary angioplasty

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Abstract
The role of A1 adenosine receptors in preconditioning in humans is unknown. To establish whether bamiphylline, a selective antagonist of A1 adenosine receptors, abolishes ischaemic preconditioning in man, 36 consecutive patients undergoing single-vessel coronary angioplasty were randomized to receive intravenous infusion of bamiphylline (5 mg. kg−1)or placebo (0·9% NaCl) immediately prior to the procedure. The mean values (±1 SD) of ST segment shifts on the surface and intracoronary electrocardiograms were measured at the end of the first and second balloon inflations, both 2 min long. The severity of cardiac pain was obtained at the same time using a visual analogue scale. In bamiphylline-treated patients, the mean ST segment shift and the severity of cardiac pain during the second inflation were similar to those during the first inflation (14±15 vs 16±16mm, ns and 31±28 vs 31± 29, ns, respectively). Conversely, in placebo-treated patients both the mean ST segment shift and the severity of cardiac pain during the second inflation were significantly less than those during the first inflation (10±6 vs 17±7mm, PP<0·01, respectively). Thus, bamiphylline abolishes ischaemic preconditioning observed in man during repeated coronary balloon inflations. These results suggest that, in this setting, ischaemic preconditioning is mediated, at least in part, by A adenosine receptors.

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