Asystole following regadenoson infusion in stable outpatients

Regadenoson is a selective A2A receptor agonist approved for use as a pharmacologic stress agent for myocardial perfusion imaging after several multicenter trials demonstrated its equivalence in diagnostic accuracy for the detection of coronary artery disease and a decreased incidence of serious sid...

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Bibliographic Details
Published in:Journal of nuclear cardiology 2014-10, Vol.21 (5), p.862-868
Main Authors: Rosenblatt, Jeffrey, Mooney, Deirdre, Dunn, Timothy, Cohen, Mylan
Format: Article
Language:English
Subjects:
A2A adenosine receptor agonists
adenosine
Adenosine A2 Receptor Agonists - adverse effects
Aged
Ambulatory Care
Cardiology
Coronary Artery Disease - complications
Coronary Artery Disease - diagnostic imaging
Exercise Test - adverse effects
Female
Heart Arrest - chemically induced
Heart Arrest - diagnosis
Heart Arrest - prevention & control
Humans
Imaging
Infusions, Intravenous
Male
Medicine
Medicine & Public Health
Myocardial Perfusion Imaging - adverse effects
Nuclear Medicine
Original Article
pharmacologic stress
Purines - adverse effects
Pyrazoles - adverse effects
Radiology
Vasodilator Agents - adverse effects
vasodilator stress
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Summary:Regadenoson is a selective A2A receptor agonist approved for use as a pharmacologic stress agent for myocardial perfusion imaging after several multicenter trials demonstrated its equivalence in diagnostic accuracy for the detection of coronary artery disease and a decreased incidence of serious side effects as compared to adenosine. Recently, the FDA released a safety announcement advising of the rare but serious risk of heart attack and death associated with regadenoson and adenosine in cardiac stress testing, particularly in patients with unstable angina or cardiovascular instability. We report two cases of asystole with hemodynamic collapse in stable outpatients soon after receiving a standard regadenoson injection. The prevalence of potentially life threatening bradycardia, including asystole, associated with the use of regadenoson may be greater than previously expected. These cases highlight the need for cardiac stress labs to anticipate the potential for serious side effects with all patients during the administration of coronary vasodilators.
ISSN:1071-3581
1532-6551
DOI:10.1007/s12350-014-9898-0