Effects of mitochondrial ATP-sensitive potassium channel activation (nicorandil) in patients with angina pectoris undergoing elective percutaneous coronary interventions

Zhu, Houyong; Xu, Xiaoqun; Fang, Xiaojiang; Zheng, Jianwu; Chen, Tielong; Huang, Jinyu

doi:10.1097/md.0000000000014165

Cited by 14 publications

(9 citation statements)

References 30 publications

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“…Clinically, nicorandil is applied as a treatment of chronic stable angina in patients with effort-induced symptoms arising from epicardial coronary artery stenoses, coronary vasospasm and microvascular dysfunction 10. A few clinical trials have indicated that nicorandil is effective to reduce the frequency of angina episodes and improve exercise capacity in patients with stable angina 11. Moreover, nicorandil is well tolerated by most patients, with a satisfactory safety profile as evidenced by accumulating studies 12.…”

Section: Introductionmentioning

confidence: 99%

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

Xu¹,

Wang²,

Li³

et al. 2019

DDDT

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Background: Nicorandil prior to reperfusion by primary percutaneous coronary intervention (PCI) in patients with ST-segment elevated myocardial infarction (STEMI) has been suggested to be beneficial. However, results of previous randomized controlled trials (RCTs) were not consistent. We aimed to perform a meta-analysis to systematically evaluate the effect of periprocedural nicorandil in these patients. Methods: Related studies were obtained by searching PubMed, Embase and Cochrane’s Library. Effects of perioperative nicorandil on the incidence of no-reflow phenomenon (NRP), corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC), wall motion score (WMS), left ventricular ejection fraction (LVEF), heart failure (HF) exacerbation of rehospitalization and incidence of major cardiovascular adverse events (MACE) were analyzed. Results: Eighteen RCTs with 2,055 patients were included. Treatment of nicorandil prior to PCI significantly reduced the incidence of NRP (risk ratio [RR]: 0.47, P <0.001), and reduced CTFC (weighed mean difference [WMD]: −4.54, P <0.001) immediately after PCI. Moreover, although nicorandil did not significantly affect WMS (WMD: 0.04, P =0.91), treatment of nicorandil significantly increased LVEF in STEMI patients undergoing primary PCI (WMD: 1.89%, P <0.001). In addition, nicorandil significantly reduced the risk of HF exacerbation or rehospitalization (RR: 0.44, P =0.001) and the incidence of MACE (RR: 0.68, P <0.001). Further analyses showed that effects of nicorandil on LVEF, HF exacerbation and MACE were consistent within one month after PCI and during follow-up. Conclusions: Periprocedural nicorandil improves coronary blood flow, cardiac systolic function and prognosis in STEMI patients receiving primary PCI.

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Section: Introductionmentioning

confidence: 99%

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

Xu¹,

Wang²,

Li³

et al. 2019

DDDT

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“…This was partly consistent with the results of previous studies, which claimed that nicorandil had a negative effect on PMI. [ 34 – 38 ] Note that a moderate decrease in the incidence of PMI was detected after the intracoronary administration of nicorandil and alprostadil via a targeted perfusion microcatheter, which differed sharply in the way of drug administration from those studies. Since this trial was not primarily designed to determine the comparative efficacy of these drugs on PMI, future studies are encouraged to elucidate the cardiac protective effect of intracoronary nicorandil and alprostadil from this perspective.…”

Section: Discussionmentioning

confidence: 95%

Myocardial protective effect of intracoronary administration of nicorandil and alprostadil via targeted perfusion microcatheter in patients undergoing elective percutaneous coronary intervention

et al. 2021

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Background: The aim of the study was to evaluate the efficacy of nicorandil and alprostadil on myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI). Methods: In this prospective, single-blinded, randomized controlled study, 90 consecutive patients scheduled for elective PCI for de novo coronary lesions were assigned to the nicorandil, alprostadil, and nitroglycerin groups in a 1:1:1 ratio. Drugs were administered intracoronary via a targeted perfusion microcatheter. The primary endpoint was the thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC). Additionally, the corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), and incidence of periprocedural myocardial injury (PMI) were assessed. Results: Both nicorandil and alprostadil were significantly effective in reducing TMPFC (114.6 ± 33.7 vs 93.4 ± 30.9, P = .016; 114.3 ± 34.3 vs 94.7 ± 33.3, P = .029, respectively). Similar findings were observed in the improvement of cTFC (20.3 ± 10.5 vs 13.5 ± 5.0, P = .003; 20.2 ± 7.4 vs 15.2 ± 5.2, P = .003, respectively) and percentage of TMPG 3 (100% vs 82.8%, P = .052; 83.3% vs 96.7%, P = .196, respectively); whereas, nitroglycerin produced a limited effect on TMPFC (114.4 ± 30.9 vs 112.1 ± 31.9, P = .739), cTFC (19.4 ± 7.2 vs 19.3 ± 7.2, P = .936), and percentage of TMPG 3 (86.7% vs 86.7%, P = 1.000). No significant difference was found in the incidence of PMI (16.7% vs 16.0% vs 27.6%, P = .537), though it was comparatively lower in the nicorandil and alprostadil groups. Furthermore, the intracoronary administration of nicorandil and alprostadil had a mild effect on blood pressure and heart rate. Conclusions: The intracoronary administration of nicorandil and alprostadil via a targeted perfusion microcatheter was more effective in improving myocardial perfusion in patients undergoing elective PCI than nitroglycerin.

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“…The study by Zhang et al [ 36 ] suggested that nicorandil, as an adjuvant therapy with PCI, can reduce total mortality and cardiovascular death in patients with primary PCI (PPCI) and elective PCI (EPCI) and reduce heart failure in PPCI patients. Zhu et al [ 37 ] said that nicorandil did not reduce the overall incidence of perioperative complications and the incidence of major adverse cardiac events (MACE) in patients with angina pectoris who underwent elective PCI. Li et al [ 38 ] suggested that nicorandil could improve clinical outcomes in terms of perioperative myocardial infarction (MI).…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Nicorandil for Periprocedural Myocardial Injury in Patients Undergoing PCI: A Meta-Analysis

Song

et al. 2020

Journal of Interventional Cardiology

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Purpose. To evaluate the efficacy and safety of nicorandil for periprocedural myocardial injury in patients undergoing PCI through meta-analysis of randomized controlled trials. Methods. We analyzed the clinical data of patients including the incidence of periprocedural myocardial injury (PMI) and major adverse cardiovascular events (MACE) from selected articles. RCTs were retrieved from medical literature databases. RR and 95% confidence intervals (CI) were calculated to compare the endpoints. Results. In total, 15 articles (16 trial comparisons) were retrieved which contained 2221 patients. In general, 1130 patients (50.9%) were randomized to the experimental group, whereas 1091 patients (49.1%) were randomized to the control group. The result showed that nicorandil significantly reduced the incidence of PMI and MACE after PCI compared to the control group. Conclusions. Overall, early use of nicorandil in patients undergoing percutaneous coronary intervention (PCI) was associated with a significant reduction of PMI and MACE.

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Effects of mitochondrial ATP-sensitive potassium channel activation (nicorandil) in patients with angina pectoris undergoing elective percutaneous coronary interventions

Abstract: Supplemental Digital Content is available in the text

Cited by 14 publications

References 30 publications

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

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

Myocardial protective effect of intracoronary administration of nicorandil and alprostadil via targeted perfusion microcatheter in patients undergoing elective percutaneous coronary intervention

The Efficacy and Safety of Nicorandil for Periprocedural Myocardial Injury in Patients Undergoing PCI: A Meta-Analysis

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