Regadenoson (Lexiscan) for Patients with CAD and Stents with Family History of MI
Regadenoson (Lexiscan) is appropriate for your patient with coronary artery disease (CAD) and stents who has a family history of a father dying from myocardial infarction, as it is an FDA-approved pharmacologic stress agent for myocardial perfusion imaging in patients unable to undergo adequate exercise stress. 1
Indications and Appropriateness
- Regadenoson is indicated for radionuclide myocardial perfusion imaging (MPI) in patients unable to undergo adequate exercise stress, which is relevant for patients with established CAD and stents 1
- Family history of premature cardiovascular disease (CVD) is defined as CVD occurring in a first-degree male relative <55 years of age or a first-degree female relative <65 years of age, and increases baseline CVD risk by 1.5-2.0 fold 2
- In patients with established CAD, family history should inform the aggressiveness of secondary prevention rather than dictate imaging strategy 3
Safety Considerations for Patients with CAD and Stents
- Avoid use in patients with symptoms or signs of acute myocardial ischemia, unstable angina, or cardiovascular instability, as these patients may be at greater risk of serious cardiovascular reactions to regadenoson 1
- Cardiac resuscitation equipment and trained staff should be available before administering regadenoson 1
- Common side effects include warmth and chest discomfort, which are typically mild, short in duration, and self-limiting 4
Precautions and Contraindications
- Regadenoson is contraindicated in patients with second- or third-degree AV block or sinus node dysfunction unless these patients have a functioning artificial pacemaker 1
- Use with caution in patients with left main coronary artery stenosis, as they may be at higher risk for serious hypotension 1
- Patients should avoid consumption of any products containing methylxanthines (including caffeinated beverages and drugs) for at least 12 hours before the scheduled MPI 1
Risk Assessment in Patients with Family History
- Family history of MI is an important risk factor that should be considered in the overall cardiovascular risk assessment 5
- The strength of risk increases with younger age of onset, increasing number of affected relatives, and closer genealogical proximity 2
- Almost 75% of individuals with premature coronary heart disease have a positive family history, highlighting opportunities for prevention 2
Administration Protocol
- Administer regadenoson as an intravenous injection within 10 seconds into a peripheral vein using a 22 gauge or larger catheter or needle 1
- Follow with a 5 mL saline flush immediately after the injection 1
- Administer the radionuclide myocardial perfusion imaging agent 10–20 seconds after the saline flush 1
Monitoring and Management of Adverse Effects
- Monitor for potential adverse effects including myocardial ischemia, sinoatrial and atrioventricular nodal block, atrial fibrillation/flutter, hypersensitivity reactions, and hypotension 1
- If serious reactions occur, consider the use of aminophylline, an adenosine antagonist, to shorten the duration of increased coronary blood flow induced by regadenoson 1
- Closely monitor hemodynamic parameters including heart rate and blood pressure during and after administration 4
Conclusion for Patient Management
- For patients with CAD and stents, functional imaging tests like regadenoson stress MPI are preferred over anatomical assessment 3
- The patient's family history of MI should inform aggressive secondary prevention strategies but does not contraindicate the use of regadenoson for stress testing 3, 2
- Ensure optimal medical therapy and risk factor modification as part of the comprehensive management approach for this patient with established CAD 5