Effect of nicorandil administration on myocardial microcirculation during primary percutaneous coronary intervention in patients with acute myocardial infarction

Abstract

IntroductionPrevention of the no-reflow phenomenon has a crucial role in primary percutaneous coronary intervention (P-PCI) procedures.AimTo assess the effects of early intracoronary administration of nicorandil (NIC) during P-PCI on myocardial microcirculation in patients with acute myocardial infarction (AMI).Material and methodsA total of 120 patients with first acute anterior wall ST segment elevation myocardial infarction who underwent P-PCI were randomly divided into two groups: the NIC group (A, n = 60) and the placebo group (B, n = 60). Before stent placement, NIC or normal saline was injected using a guiding catheter. The thrombolysis in myocardial infarction (TIMI) grade, TIMI myocardial perfusion grade (TMPG), resolution of ST segment elevation (defined as > 50% decrease in ST elevation) 1 h after surgery, and 99Tcm-methoxyisobutyl isocyanide (MIBI) rest myocardial perfusion imaging (MPI) via single-photon emission computed tomography (99Tcm-MIBI SPECT) findings 10 days after surgery were compared between the two groups.ResultsThe number of patients who achieved TIMI grade 3 (96.67% vs. 86.67%; p = 0.047) and TMPG 3 (95% vs. 83.33%; p = 0.040) was higher in the NIC group than in the placebo group. Resolution of ST segment elevation occurred in 95% and 81.67% of the patients in the NIC and placebo groups, respectively (p = 0.023); the MPI score of the two groups was 4.1 ±1.89 and 7.3 ±2.65, respectively (p = 0.014).ConclusionsEarly coronary administration of NIC can significantly reduce the damage in the myocardial microcirculation caused by P-PCI and the myocardial infarct size in patients with AMI.

The impact of oral nicorandil pre-treatment on ST resolution and clinical outcome of patients with acute ST-segment elevation myocardial infarction undergoing primary coronary angioplasty: A randomized placebo controlled trial

“…This finding is in contrary to those found in the most of previous studies where the drug was used through either intravenous or intracoronary route. [6][7][8][9]13,14 Also, in the present study, oral nicorandil did not have any effect on infarct size reduction and left ventricular function as evident by similar peak cardiac troponin and left ventricular ejection fraction (Table 1) . These findings are consistent with those reported by Kitakaze et al, who showed the intravenous nicorandil with no effect on either infarct size or left ventricular function.…”

“…5 Previous studies have shown that intravenous or intracoronary nicorandil may have cardioprotective effects and may lead to increased myocardial salvage in patients with STEMI undergoing mechanical reperfusion. [6][7][8][9][10] However, in a majority of previous studies, nicorandil has been administered either intravenously or intracoronary, and there is paucity of data on possible cardioprotective effect of oral nicorandil before primary coronary angioplasty. 11,12 Therefore, in the present study, we aimed to assess cardioprotective effect of oral nicorandil during primary angioplasty in patients with STEMI.…”

ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

“…The current guidelines of ESC, however, permit the application of IIb/IIIa inhibitors as bailout therapy in the case of large thrombus, slow-or no-reflow, and other thrombotic complications [27]. Furthermore, a recently published study demonstrated the beneficial effect of early intracoronary administration of nicorandil on microcirculation damage [32]. Other strategies aimed at reduction of reperfusion injury, including cyclosporine, which activates mitochondrial potassium channels, failed to improve clinical outcomes and prevent LV remodeling [33], despite previous experimental studies indicating its beneficial effects on infarct size and microvascular obstruction [34].…”

<p>Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials [Letter]</p>

“…Thirdly, we are confused about the study by Feng et al We found that they publish another report of the same trial (both are registered in the clinicaltrial.gov, the trial registration number was NCT02435797) 5. However, in that report the total number of included patients was 120; thus, the number was 170 in another report.…”