Effects of Intracoronary Nicorandil on Myocardial Microcirculation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials

Shi, Liye; Chen, Ling; Qi, Guoxian; Tian, Wen; Zhao, Shijie

doi:10.1007/s40256-019-00368-y

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…45,46 The beneficial effects of nicorandil combined with PCI in patients with AMI in reducing the NRP, cTFC, and MACEs, and improving the LEVF have been demonstrated in several meta-analyses. 8,39,42,47 The present study, which included more recent clinical trials, further proved these effects of nicorandil. As an update to other studies, we also conducted TSA to assess the possibility of the effect size of the present meta-analysis to change according to potential future data and the requirement for future data.…”

Section: Discussionsupporting

confidence: 72%

“…There is controversy whether intracoronary administration, which delivers the drug directly to the target vessel at higher concentrations, is more effective for prevention and treatment of the NRP in patients with AMI undergoing PCI than other types of administration. 39 However, subgroup analysis showed that intracoronary, intravenous, and combined intracoronary and intravenous administration were equally effective in reducing the NRP, TMPG 2, reperfusion arrhythmia and cTFC, as well as increasing complete STR. In some functional (LVEF and LVEDVI) and clinical (MACEs and new MI) outcomes, discrepant results were found with different administration routes.…”

Section: Discussionmentioning

confidence: 97%

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Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis

Zhou

Cheng

et al. 2020

J Int Med Res

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Objective There is controversy whether nicorandil treatment has cardioprotective effects in patients with acute myocardial infarction (AMI) following percutaneous coronary intervention (PCI). This meta-analysis was conducted to assess the efficacy of nicorandil on functional and clinical outcomes after PCI. Methods Systematic databases were searched to retrieve studies that compared the effect of nicorandil with a control group in patients with AMI who underwent PCI. Outcomes related to coronary blood flow, and functional and clinical outcomes were extracted and a meta-analysis was performed. Trial sequential analysis was conducted to estimate the required sample size for statistical power. Results Twenty-four trials involving 2965 patients with AMI were enrolled. Pooled results showed that nicorandil treatment significantly suppressed the incidence of no-reflow phenomenon and reperfusion arrhythmia after reperfusion, improved the left ventricular ejection fraction and left ventricular end-systolic volume index, and reduced major adverse cardiovascular events and cardiovascular death. Trial sequential analysis confirmed the effect of nicorandil in reducing the incidence of no-reflow phenomenon and follow-up major adverse cardiovascular events in patients with AMI after PCI. Conclusion Our findings suggest that nicorandil treatment adjunctive to reperfusion therapy improves myocardial reperfusion, cardiac function, and clinical outcomes in patients with AMI.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 97%

Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis

Zhou

Cheng

et al. 2020

J Int Med Res

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“…206 Nevertheless, several agents considered protective against mitochondrial injury have been investigated in animal experiments, such as caspase inhibitors, 207 and poly(ADP-ribose) polymerase-1 inhibitors among others 208 ; some agents are being tested clinically, such as cyclosporin A and nicorandil, both inhibitors of mitochondrial PTP, affecting the progression to cell death in the setting of I/R, albeit without having documented clinically important efficacy. 190,[209][210][211][212] MANOLIS ET AL.…”

Section: Inhibitors Of Apoptosismentioning

confidence: 99%

“…Attempts to develop clinically useful inhibitors of programmed cell death (apoptosis) and regulated necrosis (necroptosis) for cardioprotective purposes, for example, to limit cell death after reperfusion, have not been successful 206 . Nevertheless, several agents considered protective against mitochondrial injury have been investigated in animal experiments, such as caspase inhibitors, 207 and poly(ADP‐ribose) polymerase‐1 inhibitors among others 208 ; some agents are being tested clinically, such as cyclosporin A and nicorandil, both inhibitors of mitochondrial PTP, affecting the progression to cell death in the setting of I/R, albeit without having documented clinically important efficacy 190,209–212 …”

Section: Targeting the Mitochondriamentioning

confidence: 99%

Mitochondrial dysfunction in cardiovascular disease: Current status of translational research/clinical and therapeutic implications

Manolis¹,

Manolis

et al. 2020

Medicinal Research Reviews

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Mitochondria provide energy to the cell during aerobic respiration by supplying ~95% of the adenosine triphosphate (ATP) molecules via oxidative phosphorylation. These organelles have various other functions, all carried out by numerous proteins, with the majority of them being encoded by nuclear DNA (nDNA). Mitochondria occupy ~1/3 of the volume of myocardial cells in adults, and function at levels of high‐efficiency to promptly meet the energy requirements of the myocardial contractile units. Mitochondria have their own DNA (mtDNA), which contains 37 genes and is maternally inherited. Over the last several years, a variety of functions of these organelles have been discovered and this has led to a growing interest in their involvement in various diseases, including cardiovascular (CV) diseases. Mitochondrial dysfunction relates to the status where mitochondria cannot meet the demands of a cell for ATP and there is an enhanced formation of reactive‐oxygen species. This dysfunction may occur as a result of mtDNA and/or nDNA mutations, but also as a response to aging and various disease and environmental stresses, leading to the development of cardiomyopathies and other CV diseases. Designing mitochondria‐targeted therapeutic strategies aiming to maintain or restore mitochondrial function has been a great challenge as a result of variable responses according to the etiology of the disorder. There have been several preclinical data on such therapies, but clinical studies are scarce. A major challenge relates to the techniques needed to eclectically deliver the therapeutic agents to cardiac tissues and to damaged mitochondria for successful clinical outcomes. All these issues and progress made over the last several years are herein reviewed.

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“…The infusion of nicorandil via intracoronary and intravenous routes is widespread in STEMI patients. However, the efficacy of intracoronary administration of nicorandil over other forms for the prevention and treatment of NRP in STEMI patients is still debated [ 6 ]. The current investigation discovered that early intracoronary administration of nicorandil treatment was beneficial in decreasing NRP, and reperfusion arrhythmia, which was confirmed by a previous study done in 170 STEMI Chinese patients by Feng et al, 81 stable or unstable angina patients by Hwang et al [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

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

Gupta¹,

Parihar²,

Tripathi³

2022

Cureus

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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.

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Effects of Intracoronary Nicorandil on Myocardial Microcirculation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials

Cited by 8 publications

References 32 publications

Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis

Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis

Mitochondrial dysfunction in cardiovascular disease: Current status of translational research/clinical and therapeutic implications

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

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