Raising Awareness of ST-Segment Elevation Myocardial Infarction Triggered by Intravenous Regadenoson for Cardiac Stress Testing

Regadenoson is a selective A2A adenosine receptor agonist vasodilator that is widely used for pharmacologic cardiac stress testing. Although generally considered safe with less side effects than adenosine, regadenoson can have serious side effects. We report here 4 patients who developed ST-segment...

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Main Author: Ruihai Zhou, MSc, MD
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:JACC: Case Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666084925006709
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author Ruihai Zhou, MSc, MD
author_facet Ruihai Zhou, MSc, MD
author_sort Ruihai Zhou, MSc, MD
collection DOAJ
description Regadenoson is a selective A2A adenosine receptor agonist vasodilator that is widely used for pharmacologic cardiac stress testing. Although generally considered safe with less side effects than adenosine, regadenoson can have serious side effects. We report here 4 patients who developed ST-segment elevation myocardial infarction (STEMI) or STEMI equivalent due to acute thrombotic occlusion of variable coronary arteries including left main coronary artery, normal and anomalous right coronary artery, and left circumflex coronary artery, with characteristic electrocardiogram abnormalities. The STEMI occurred as early as 1 minute and as late as 30 minutes after regadenoson administration. Therefore, development of localizing acute ST-segment elevation (STE) or STE in aVR with reciprocal ST-segment depression on the electrocardiograms as seen in these cases portends underlying acute coronary obstruction. Attention should also be paid to potential late occurring STEMI. When used in cardiac stress testing, discussing potential serious side effects of regadenoson including STEMI should be part of informed consent.
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spelling doaj-art-04eb65f413b24debb053a697508d010a2025-08-20T02:43:24ZengElsevierJACC: Case Reports2666-08492025-07-01301710389210.1016/j.jaccas.2025.103892Raising Awareness of ST-Segment Elevation Myocardial Infarction Triggered by Intravenous Regadenoson for Cardiac Stress TestingRuihai Zhou, MSc, MD0Address for correspondence: Dr Ruihai Zhou, Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA.; Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USARegadenoson is a selective A2A adenosine receptor agonist vasodilator that is widely used for pharmacologic cardiac stress testing. Although generally considered safe with less side effects than adenosine, regadenoson can have serious side effects. We report here 4 patients who developed ST-segment elevation myocardial infarction (STEMI) or STEMI equivalent due to acute thrombotic occlusion of variable coronary arteries including left main coronary artery, normal and anomalous right coronary artery, and left circumflex coronary artery, with characteristic electrocardiogram abnormalities. The STEMI occurred as early as 1 minute and as late as 30 minutes after regadenoson administration. Therefore, development of localizing acute ST-segment elevation (STE) or STE in aVR with reciprocal ST-segment depression on the electrocardiograms as seen in these cases portends underlying acute coronary obstruction. Attention should also be paid to potential late occurring STEMI. When used in cardiac stress testing, discussing potential serious side effects of regadenoson including STEMI should be part of informed consent.http://www.sciencedirect.com/science/article/pii/S2666084925006709acute coronary syndromecoronary angiographymyocardial infarction
spellingShingle Ruihai Zhou, MSc, MD
Raising Awareness of ST-Segment Elevation Myocardial Infarction Triggered by Intravenous Regadenoson for Cardiac Stress Testing
JACC: Case Reports
acute coronary syndrome
coronary angiography
myocardial infarction
title Raising Awareness of ST-Segment Elevation Myocardial Infarction Triggered by Intravenous Regadenoson for Cardiac Stress Testing
title_full Raising Awareness of ST-Segment Elevation Myocardial Infarction Triggered by Intravenous Regadenoson for Cardiac Stress Testing
title_fullStr Raising Awareness of ST-Segment Elevation Myocardial Infarction Triggered by Intravenous Regadenoson for Cardiac Stress Testing
title_full_unstemmed Raising Awareness of ST-Segment Elevation Myocardial Infarction Triggered by Intravenous Regadenoson for Cardiac Stress Testing
title_short Raising Awareness of ST-Segment Elevation Myocardial Infarction Triggered by Intravenous Regadenoson for Cardiac Stress Testing
title_sort raising awareness of st segment elevation myocardial infarction triggered by intravenous regadenoson for cardiac stress testing
topic acute coronary syndrome
coronary angiography
myocardial infarction
url http://www.sciencedirect.com/science/article/pii/S2666084925006709
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