Feasibility of intracoronary nicorandil for inducing hyperemia on fractional flow reserve measurement: Comparison with intracoronary papaverine

Matsumoto, Hidenari; Mikuri, Mikiko; Masaki, Ryota; Tanaka, Hideaki; Ogura, Kunihiro; Arai, Taitou; Sakai, Rikuo; Oishi, Yosuke; Okada, Naoya; Shinke, Toshiro

doi:10.1016/j.ijcard.2020.05.013

Cited by 10 publications

(10 citation statements)

References 35 publications

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“…Although the additional dose of intracoronary nicorandil may be one of the simple and safe ways for confirmation of maximal hyperemia, it was reported that an additional 4 mg dose of nicorandil was not associated with a greater decline in the FFR than a 2 mg dose of nicorandil. 9) Study limitations: There are several limitations to this study. First, it had a single-center design and enrolled a relatively small sample size from the Japanese population.…”

Section: Discussionmentioning

confidence: 99%

“…The present findings suggest that NIC preadministration suppresses the development of PAPinduced VT due to reductions in the rate of PAP-induced QTc prolongation. 9) Furthermore, NIC use alone can aid in the achievement of sufficient hyperemia during FFR measurement in most cases. Therefore, the routine injection of intracoronary PAP with NIC in daily clinical practice may not be viable due to the procedural complexity and associated high costs.…”

Section: Discussionmentioning

confidence: 99%

“…6) Intracoronary PAP is the most po-tent vasodilator employed in the achievement of maximal hyperemia for FFR and is essentially the only intracoronary injection for which the production of a pressure pullback curve is possible. [7][8][9] However, its use may provoke the development of malignant ventricular tachycardia (VT) due to QTc prolongation. 8,[10][11][12] NIC is a drug with both nitrate-like and ATP-sensitive potassium channel (K+ ATP)-activating properties.…”

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Clinical Efficacy of Intracoronary Papaverine After Nicorandil Administration for Safe and Optimal Fractional Flow Reserve Measurement

et al. 2021

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Fractional flow reserve (FFR) is considered the standard for assessment of the physiological significance of coronary artery stenosis. Intracoronary papaverine (PAP) is the most potent vasodilator used for the achievement of maximal hyperemia. However, its use can provoke ventricular tachycardia (VT) due to excessive QT prolongation. We evaluated the clinical efficacy and safety of the administration of PAP after nicorandil (NIC), a potassium channel opener that prevents VT, for optimal FFR measurement.A total of 127 patients with 178 stenoses were enrolled. The FFR values were measured using NIC (NIC-FFR) and PAP (PAP-FFR). We administered PAP following NIC (NIC-PAP). Changes in the FFR and electrogram parameters (baseline versus NIC versus PAP) were assessed and the incidence of arrhythmias after PAP was evaluated. In addition, we analyzed another 41 patients with 51 stenoses by assessing the FFR using PAP before NIC (PAP-NIC). After propensity score matching, the electrogram parameters between 2 groups were compared.The mean PAP-FFR was significantly lower than the mean NIC-FFR (0.82 ± 0.11 versus 0.81 ± 0.11, P < 0.05). The mean baseline-QTc, NIC-QTc, and PAP-QTc values were 425 ± 37 ms 1/2 , 424 ± 41 ms 1/2 , and 483 ± 54 ms 1/2 , respectively. VT occurred in only 1 patient (0.6%). Although PAP induced QTc prolongation (P < 0.05), the PAP-QTc duration was significantly shorter in NIC-PAP compared to PAP-NIC (P < 0.05).The administration of PAP with NIC may induce sufficient hyperemia and prevent fatal arrhythmia through reductions in the PAP-induced QTc prolongation during FFR measurement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Clinical Efficacy of Intracoronary Papaverine After Nicorandil Administration for Safe and Optimal Fractional Flow Reserve Measurement

et al. 2021

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“… 21 , 27 Intracoronary nicorandil has proven safe clinically. 10 – 13 This trial found that nicorandil significantly reduced the levels of pro-inflammatory indicators, including CRP, IL-1β, IL-6, and TNF-α, 24 hours after PCI. Furthermore, the drug also elevated the levels of anti-inflammatory cytokines, including IL-1RA, IL-10, and IL-13, 24 hours after PCI.…”

Section: Discussionmentioning

confidence: 99%

“… 10 Recently, several studies described the safety of the intravenous or intracoronary injection of nicorandil and its efficacy in improving myocardial perfusion during PCI. 10 – 13 Nicorandil also reduces the incidence of MNR, thereby reversing the possible poor prognosis of patients undergoing PCI. 10 , 13 Furthermore, nicorandil administration at the time of primary PCI was associated with reduced rates of major adverse cardiovascular events (MACE) both in the hospital and after discharge.…”

Section: Introductionmentioning

confidence: 99%

Effects of nicorandil on systemic inflammation and oxidative stress induced by percutaneous coronary intervention in patients with coronary heart disease

Zong

et al. 2021

J Int Med Res

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Objective The present study investigated the effects of a bolus intracoronary injection of nicorandil on systemic inflammation and oxidative stress induced by percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods Patients undergoing coronary angiography (CAG) were enrolled into the CAG group (n = 30). Patients undergoing PCI were randomly divided into the PCI (n = 30) and PCI + nicorandil groups (n = 30). Results Blood taken from patients in the placebo group 24 hours after PCI exhibited significant increases in the expression of inflammatory indicators and mild increases in the expression of anti-inflammatory indicators. The intracoronary injection of nicorandil reversed the elevation of inflammatory indicators and significantly increased the levels of anti-inflammatory indicators in the blood of patients with PCI. Blood taken from patients in the placebo group 24 hours after PCI also displayed significant decreased superoxide dismutase levels and increased malondialdehyde levels. Nicorandil treatment reversed these changes of oxidative stress marker levels. Conclusions These results indicated the possible medical application of intracoronary injections of nicorandil for reducing systemic inflammation and oxidative stress in the peripheral blood of patients undergoing PCI.

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Pd/Pa fluctuation with continuous ATP administration indicates inaccurate FFR measurement caused by insufficient hyperemia

Yoneyama,

Hoyano,

Ozaki

et al. 2024

Heart Vessels

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Feasibility of intracoronary nicorandil for inducing hyperemia on fractional flow reserve measurement: Comparison with intracoronary papaverine

Cited by 10 publications

References 35 publications

Clinical Efficacy of Intracoronary Papaverine After Nicorandil Administration for Safe and Optimal Fractional Flow Reserve Measurement

Clinical Efficacy of Intracoronary Papaverine After Nicorandil Administration for Safe and Optimal Fractional Flow Reserve Measurement

Effects of nicorandil on systemic inflammation and oxidative stress induced by percutaneous coronary intervention in patients with coronary heart disease

Pd/Pa fluctuation with continuous ATP administration indicates inaccurate FFR measurement caused by insufficient hyperemia

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