Effects of Age, Gender, Obesity, and Diabetes on the Efficacy and Safety of the Selective A2A Agonist Regadenoson Versus Adenosine in Myocardial Perfusion ImagingIntegrated ADVANCE-MPI Trial Results
Manuel D. Cerqueira, MD, FACC*,*,
Patricia Nguyen, MD ,
Peter Staehr, MD,
S. Richard Underwood, MD, FACC ,
Ami E. Iskandrian, MD, MACC on behalf of the ADVANCE-MPI Trial Investigators
* Departments of Nuclear Medicine and Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Cardiovascular Therapeutics, Inc., Palo Alto, California
Imperial College London, Royal Brompton Hospital, London, England
University of Alabama, Birmingham, Alabama.
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Figure 1 Agreement Rates for Ischemia in Combined ADVANCE MPI 1 and 2
In 1,871 subjects, 3 blinded experts independently scored images on a 5-point scale using 17-segments and ischemia was categorized as 0 to 1 (no to minimal), 2 to 4 (small to moderate), or  5 (large). The overall average ischemia agreement rates between adenosine–adenosine and adenosine–regadenoson was 0.62 ± 0.03 and 0.63 ± 0.02 with an agreement difference of 0% (95% CI –6.2% to 6.8%), respectively. Regadenoson was noninferior to adenosine for detection of ischemia. ADVANCE MPI= ADenoscan Versus regAdenosoN Comparative Evaluation for Myocardial Perfusion Imaging; CI = confidence interval; SE = standard error.
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Figure 2 Comparison of SSS and SDS for Initial Adenosine and Randomized Scan
Using the rounded average of 3 readers for adenosine-adenosine and adenosine-regadenoson scoring, mean summed stress score (SSS) (A) and summed difference score (SDS) (B) differences were close to 0 and standard deviations (SDs) were similar for the 2 arms for the ADVANCE MPI 1 and 2 trials. The differences between the initial adenosine and randomization to regadenoson were no different than randomization to repeat adenosine. Results of ADVANCE MPI 1 are shown.
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