Effects of adenosine on oxidative stress and inflammation in patients with coronary heart disease underlying percutaneous coronary intervention

Objective: To determine whether rapid intracoronary adenosine administration attenuates percutaneous coronary intervention (PCI)–induced systemic inflammation and oxidative stress in patients with coronary artery disease. Methods: This prospective, randomized controlled trial enrolled patients undergoing coronary angiography (coronary angiography group) or PCI. Patients undergoing PCI were assigned to receive intracoronary adenosine (PCI + adenosine group) or placebo (PCI group). Blood levels of inflammatory markers (e.g. cytokines), anti-inflammatory mediators, and oxidative stress indicators (superoxide dismutase and malondialdehyde) were measured before and 24 h after the procedure. Results: Compared to the coronary angiography group, patients undergoing PCI who received placebo exhibited concurrent elevations in inflammatory and anti-inflammatory markers at 24 h. Intracoronary adenosine significantly suppressed the rise in the levels of inflammatory markers (e.g. interleukin-6 reduced by 35% vs. placebo) and enhanced anti-inflammatory responses (e.g. interleukin-10 increased by 40% vs. placebo). Following PCI, oxidative stress was evident in placebo-treated patients, as reflected by decreased superoxide dismutase activity (15% reduction) and increased malondialdehyde levels (30% elevation). Adenosine restored superoxide dismutase activity to near-baseline levels and reduced malondialdehyde elevation by 85% compared to placebo. Conclusions: Intracoronary adenosine mitigates PCI-associated systemic inflammation and oxidative stress by rebalancing inflammatory pathways and preserving redox homeostasis. These findings highlight its potential as a therapeutic adjunct for improving clinical outcomes following PCI and warrant further validation in large-scale trials. Clinical Trial Registration: Chinese Clinical Trial Registry (ChiCTR); identifier: ChiCTR1800019349. © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).