The effects of nicorandil on microvascular function in patients with ST segment elevation myocardial infarction undergoing primary PCI

Abstract

BackgroundNicorandil, as a selective potassium channel opener, has dual action including coronary and peripheral vasodilatation and cardioprotective effect through ischemic preconditioning. Considering those characteristics, nicorandil was suggested to reduce the degree of microvascular dysfunction.MethodsThirty-two patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI) were included in the study. Index of microvascular resistance (IMR) was measured in all patients immediatelly after pPCI before the after administration of Nicorandil. ST segment resolution was monitored before intervention and 60 min after terminating the procedure. Echocardiographic evaluation of myocardial function and transthoracic Doppler derived Coronary flow reserve (CFR) of infarct related artery (IRA) was performed during hospitalization and 3 months later.ResultsIMR was significantly lower after administration of Nicorandil (9.9 ± 3.7 vs. 14.1 ± 5.1, p < 0.001). There was significant difference in ST segment elevation before and after primary PCI with administration of Nicorandil (6.9 ± 3.7 mm vs. 1.6 ± 1.6 mm, p < 0.001). Transthoracic Doppler CFR measurement improved after 3 months (2.69 ± 0.38 vs. 2.92 ± 0.54, p = 0.021), as well as WMSI (1.14 ± 0.17 vs. 1.07 ± 0.09, p = 0.004).ConclusionIntracoronary Nicorandil administration after primary PCI significantly decreases IMR, resulting in improved CFR and ventricular function in patients with STEMI undergoing primary PCI.

Intracoronary Nicorandil and the Prevention of the No-Reflow Phenomenon During Primary Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction

“…Chen et al analyzed intracoronary administration of nicorandil (2 mg) and showed that it could effectively treat the NRP [ 4 ]. In a previously published study by Kostic et al, intracoronary administration of nicorandil in patients with STEMI undergoing primary PCI significantly improved microvascular function by reducing the microvascular resistance index and increasing coronary flow reserve [ 20 ].…”

Comparative Prognostic Utility of Indexes of Microvascular Function Alone or in Combination in Patients With an Acute ST-Segment–Elevation Myocardial Infarction

“…There is some evidence that IMR is responsive to the effects of treatments known to have favorable cardiovascular effects, including vasodilators 51 and anti-ischemic 52 therapies. During PCI, compared with a direct stenting approach without initial balloon angioplasty, a predilatation step to disrupt and modify the plaque before stenting is associated with a higher IMR at the end of the PCI procedure.…”

The effect of nicorandil in patients with cardiac syndrome X

“…[ 23 ] Studies have shown that intracoronary nicorandil ameliorated microvascular dysfunction, which was evaluated with IMR, and improved CFR in patients with STEMI undergoing primary percutaneous coronary intervention. [ 59 , 60 ] In addition, nicorandil may improve chest pain symptoms, and regulate plasma NO and ET-1 in the coronary slow flow. [ 61 ]…”