Cardioprotective effects of single oral dose of nicorandil before selective percutaneous coronary intervention

Abstract

Objective:Nicorandil, an opener of ATP-sensitive K+ channels, was used to treat angina in patients with coronary artery disease. In this study, we aim to investigate the cardioprotective effects of single oral dose of nicorandil in patients undergoing selective percutaneous coronary intervention (PCI).Methods:One hundred and thirty-eight patients with acute coronary syndrome undergoing PCI from July 2011 to October 2012 were randomly divided into control group (group 1, n=47), 10 mg oral nicorandil group (group 2, n=45), and 20 mg oral nicorandil group (group 3, n=46) about 2 hours before procedure, respectively. Cardiac troponin I (cTnI) levels were determined at 20 ~ 24 hours after PCI.Results:There was a significant difference in the rate of any cTnI elevation among the three groups (group 1: 36.17%, group 2: 20.00%, group 3: 15.22%, p=0.0176). With respect to the frequency of cTnI elevation ≥3 and 5×the upper limit of normal (ULN), there also had statistical difference among the three groups (17.02% in group 1, 8.89% in group 2, and 4.35% in group 3, respectively for cTnI elevation ≥3× ULN, p=0.0428; 12.77% in group 1, 6.67% in group 2, and 2.17% in group 3, respectively, for cTnI elevation ≥5× ULN, p=0.0487). Logistic regression analysis showed that LVEF (OR=0.915, 95% CI=0.853-0.981) and the use of nicorandil (OR=0.516, 95% CI=0.267-0.996) before PCI were independent protective factors of myocardial injury.Conclusion:Single oral dose of nicorandil (10 mg, 20 mg) 2 hours before the PCI procedure could decrease the incidence of peri-procedure myocardial injury and PCI-related myocardial infarction.

Nicorandil in the prevention of cardiac damage and type 4A myocardial infarction with planned percutaneous coronary intervention in patients with atherosclerosis of coronary arteries

“…в течение 30 дней. Никорандил в максимальной разовой дозе назначали за 2 ч до ЧКВ, так как именно в этот период времени достигается и поддерживается максимальный эффект прекондиционирования [6]. Дополнительное назначение в минимальной суточной дозе в периоперационном периоде поддерживает этот эффект без снижения толерантности пациентов к проводимой терапии.…”

“…В настоящее время доказано снижение риска повреждения миокарда при проведении экстренной ЧКВ назначением никорандила у пациентов с ИМ [5,6]. Опираясь на результаты этих работ, мы предприняли попытку обеспечить эффект ФПК пероральной формой никорандила у больных стабильной ИБС перед плановым ЧКВ.…”

Pharmacological preconditioning. Focus on nicorandil

“…Пациентов разделили на три группы: группа конт-роля и две группы никорандила с назначением перо-рального приема 10 мг или 20 мг за два часа до ЧКВ. По результатам испытания было выявлено достовер-ное различие между тремя группами по частоте повы-шения уровня сердечного тропонина I: в группе 1 -в 36,17%, в группе 2 -в 20,00%, в группе 3 -в 15,22% случаев (р=0,0176) [44].…”

Effects of Nicorandil on All-Cause Mortality and Cardiac Events in CAD Patients Receiving PCI

“…1,2) Percutaneous coronary intervention (PCI) is an efficient method widely used in coronary artery disease (CAD) for relieving myocardial ischemia and preserving ventricular function. 3,4) However, PCI in CAD patients can cause coronary microvascular dysfunction which leads to myocardial damage and a poor long-term prognosis. [5][6][7] PCI can also lead to abnormal microvascular vasomotility and distal coronary microembolization of atheromatous and thrombotic debris and may cause aggravation of microcirculatory disturbance, abnormal myocardial metabolism, and myocardial necrosis.…”

“…[9][10][11] Nicorandil, a potent coronary vasodilator, is a hybrid of adenosine triphosphate-sensitive potassium (KATP) channel opener and nitrates are commonly prescribed for the treatment of coronary heart disease. 3,[12][13][14] A large-scale study on stable angina, the IONA study (Impact of Nicorandil in Angina) reported that nicorandil administration not only reduced death but also decreased hospitalizations for myocardial infarction and chest pain. 15) Nicorandil has cardio-protection effects in coronary heart disease patients undergoing PCI by mimicking preconditioning in the absence of ischemia through the mechanism of activation of myocardial KATP channels.…”