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

Abstract

<jats:p> <jats:bold> <jats:italic>Introduction</jats:italic> </jats:bold>: Literature has shown the effects of intravenous/intracoronary nicorandil on increased myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) treated with mechanical reperfusion. However, the possible cardioprotective effect of oral nicorandil on the clinical outcome prior to primary coronary angioplasty is not well documented. Our aim was to assess the effect of oral nicorandil on primary percutaneous coronary intervention (PPCI). <jats:bold><jats:italic>Methods:</jats:italic></jats:bold> A total of 240 patients with acute STEMI undergoing PPCI were randomly assigned to oral nicorandil (Intervention, n=116) and placebo (Control, n=124) groups. The intervention group received 20 mg oral nicorandil at the emergency department and another 20 mg oral nicorandil in the catheterization laboratory just before the procedure. The control group received matched placebo. Our primary outcome was ST-segment resolution ≥50% one hour after primary angioplasty. Secondary outcome was in-hospital major adverse cardiovascular events (MACE), defined as a composite of death, ventricular arrhythmia, heart failure and stroke. <jats:bold><jats:italic>Results:</jats:italic></jats:bold> In the patients of intervention and control groups, the occurrence of ST-segment resolution ≥ 50% were 68.1% and 62.9% respectively, (<jats:italic>P</jats:italic>=0.27). In-hospital MACE occurred less frequently in the intervention group, compared to placebo group (11.2% vs. 22.5%, <jats:italic>P</jats:italic>=0.012). <jats:bold><jats:italic>Conclusion:</jats:italic></jats:bold> Although the administration of oral nicorandil before primary coronary angioplasty did not improve ST-segment resolution in patients with acute STEMI, its promoting effects was remarkable on in-hospital clinical outcomes.</jats:p>

Efficacy and Safety of Nicorandil for Periprocedural Myocardial Injury in Patients Undergoing Pci

“…Several promising investigations are currently being conducted to prove the reliability of nicorandil use during mechanical reperfusion after the ACS. (14). Therefore, the purpose of our comprehensive meta-analysis is to investigate whether this may help protect the heart from injuries.…”

KATP channels are regulators of programmed cell death and targets for the creation of novel drugs against ischemia/reperfusion cardiac injury

“…In the randomized placebo-controlled trial including 240 patients with STEMI and PCI, it was demonstrated that pretreatment with nicorandil prior to PCI reduced the incidence of MACE by 50%. MACE included death, ventricular arrhythmia, heart failure, and stroke [175]. It was reported that nicorandil reduced the incidence of MACE in patients with AMI and PCI [165,176].…”

Chinese Expert Consensus on Microvascular Protection Strategy During Emergency Percutaneous Coronary Intervention Therapy in Patients With ST-elevation Myocardial Infarction

“…Oral nicorandil before emergency PCI can achieve similar effects to intravenous or intracoronary use. [60] A randomized controlled study showed that compared with the control group, patients with STEMI who received oral nicorandil tablets for half a year after surgery had a smaller myocardial infarction size, [61] and it is recommended to continue taking nicorandil after PCI. Small sample studies have shown that the traditional Chinese medicine Tongxinluo can improve cardiac microcirculation by protecting endothelial barrier function and can reduce the occurrence of no-reflow and infarct size in patients with STEMI.…”