Assessment of the Efficacy and Safety of Early Intracoronary Nicorandil Administration in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

Background No-reflow phenomenon (NRP) remains a challenge in ST-elevation myocardial infarction (STEMI) patients. We determined the efficacy and safety of early intracoronary administration of nicorandil as an adjunct to primary percutaneous coronary intervention (pPCI) in STEMI patients to reduce the risk of NRP. Materials and methods In this single-center case-control prospective study, 100 STEMI patients who underwent pPCI had thrombectomy performed using a suction catheter, and tirofiban (10 mg/kg) was injected distal to the vascular lesion. All patients were divided into two groups. Group A was a treatment group (nicorandil, n=50) and group B was a control group (placebo, n=50). The primary endpoint was the composite endpoint of in-hospital cardiovascular mortality or unscheduled re-hospitalization due to deterioration of congestive heart failure that was assessed with the help of brain natriuretic peptide (BNP), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction at six months following pPCI. The secondary endpoints were thrombolysis in myocardial infarction (TIMI) flow grade, TIMI myocardial perfusion grade (TMPG), the incidence of reperfusion arrhythmias like ventricular tachycardia and ventricular fibrillation, and ST segment elevation resolution (STR) on ECG following pPCI. Results The in-hospital cardiovascular mortality and re-hospitalization rates were 2% and 6% in the nicorandil group, whereas it was 6% and 14% in the control group. On the 180 th day of admission, the nicorandil group had significantly lower values of brain natriuretic peptide (348.45±112.32 pg/ml vs. 541.11±152.68 pg/ml, p=0.021) and left ventricular end-diastolic diameter (54.12±3.56 mm vs. 60.62±4.98 mm, p=0.011) than the control group. Nicorandil group had a significantly higher number of patients who attained TIMI 3 (p=0.022), TMPG 3 (p=0.034), and STR (p=0.008) than the control group. Ventricular arrhythmia was significantly lower in the nicorandil group than in the control group at 24 hours following pPCI (p=0.012). Conclusion Early intracoronary administration of nicorandil during pPCI may decrease the occurrence of NRP, in-hospital cardiovascular mortality, and re-hospitalization rates, as well as improve coronary blood flow and reduce reperfusion arrhythmia in STEMI patients.

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

“…Nicorandil abolished homocysteine‐induced coronary MVO in mice [163]. It was reported that nicorandil reduced the incidence of MVO in patients with AMI and PCI [164–168].…”

“…It was reported that nicorandil reduced the incidence of MACE in patients with AMI and PCI [165, 176]. It was found that the nicorandil prevents the development of heart failure and improves cardiac function after PCI in patients with AMI [167, 168]. Treatment with nicorandil decreased infarct size detected by cardiac magnetic resonance imaging in patients with AMI and PCI [168].…”

Impact of Early Successful Primary Percutaneous Coronary Intervention on Left Ventricular Systolic Function in ST Elevation Myocardial Infarction Patients

“…For the evaluation of regional and global left ventricular systolic function (LVSF), the two-dimensional transthoracic echocardiography (TTE) is used 8 . LVEF is an autonomous predictive aspect that is considered to be the condition commonly associated with LVSF 9 . For the estimation, the LVEF Simpson method is considered to be effective, and in addition, a skillful echocardiographer is mandatory for observation of the border of the endocardial line.…”