Fokkema 2009.

Methods	Date of publication: 2009 Design: not reported Allocation: randomised Country: Netherlands
Participants	Diagnosis: acute STEMI for PPCI Number: 448 (adenosine 226; control 222) Age, years: adenosine (mean 62.4 ± 12.2); control (mean 62.5 ± 13.0) Sex: 75% men Inclusion: chest pain suggestive of myocardial ischaemia for at least 30 minutes; time from onset of symptoms of 12 hours before hospital admission; and ECG showing ST‐segment elevation of 0.1 mV in 2 or more leads Exclusion: cardiogenic shock; presence of a life‐threatening disease with a life expectancy of 6 months; receiving pharmacotherapy for chronic obstructive pulmonary disease; no informed consent Withdrawals or losses to follow‐up: not reported
Interventions	Adenosine Dose: 2 high‐dose boluses (2 × 120 μg in 20 mL 0.9% NaCl) Route of administration: intracoronary Timing: during PPCI, after thrombus aspiration and after stenting Control Dose: 2 × 20 mL 0.9% NaCl Route of administration: intracoronary Timing: during PPCI, after thrombus aspiration and after stenting
Outcomes	All‐cause death at short term Non‐fatal MI (reinfarction) TIMI (RR 0.92, 95% Cl 0.44 to 1.90) MBG Side effects: bradycardia, hypotension, AV block Treatment cost: not reported Quality of life: not reported Follow‐up: 30 days (collected from hospital records, written questionnaires and telephone interviews)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Randomised, no further description
Allocation concealment (selection bias)	High risk	"a single‐center, prospective randomized open trial with blinded evaluation of end points"
Blinding (performance bias and detection bias) All outcomes	Low risk	"Coronary angiograms were reviewed by 2 observers blinded for treatment allocation and clinical data" "QuBE was measured blinded to clinical data and treatment allocation by 2 observers"
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	No withdrawals or drop‐outs were reported, but for some outcomes not all participant data were addressed, with no reason given. Missing outcome data were balanced across groups
Selective reporting (reporting bias)	Low risk	All outcomes stated in Methods are reported in Results
Other bias	Low risk	Not obvious