Impact of intracoronary nicorandil before stent deployment in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Abstract

The present study aimed to clarify the effect of bolus intracoronary nicorandil on inflammatory, oxidative and adherent indicators in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This randomized controlled trial (RCT) was performed to detect the inflammation and oxidative stress in intracoronary blood both before and after PCI. In total, 65 consecutive patients undergoing PCI were classified into a nicorandil therapy group (n=32) or a placebo group (n=33). All procedures were performed at Shandong University Qilu Hospital, China, during the period from March, 2016 to May, 2017. Intracoronary blood from patients who received nicorandil therapy during PCI showed no change in soluble CD40 ligand (sCD40L) concentration (1.86±0.08 vs. 1.90±0.09 ng/ml, P=0.12) but a significant increase was noted in the control group (1.87±0.17 vs. 2.82±0.26 ng/ml, P<0.01). This indicated a relative reduction in sCD40L level after PCI in the nicorandil group. We further demonstrated an increase in superoxide dismutase (SOD) activity (29.37±0.81 vs. 31.03±0.60 U/ml, P<0.001) and a reduction in lipid peroxidation (3.84±0.99 vs. 4.23±0.13 U/ml, P=0.001) in the nicorandil group but observed no change in the placebo group. ICAM-1 levels showed no change in the nicorandil group (69.54±6.89 vs. 72.01±8.25 ng/ml, P=0.83) but a significant increase in the control group after PCI in intracoronary blood (56.57±4.96 vs. 76.81±6.88 ng/ml, P=0.002). No changes were found in hs-CRP, TNFα and sVCAM-1 levels in coronary blood for both groups before and after PCI in ACS patients. Our findings demonstrate that intracoronary bolus nicorandil therapy has a significant effect on the inhibition of inflammatory indicators and oxidative stress in patients with ACS during PCI. This suggests a possible medical application of nicorandil for reducing inflammation and oxidative stress.

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

“…24 , 25 Previous research found that an intracoronary bolus of nicorandil could improve the instantaneous increases of inflammation and oxidative stress in the coronary blood of patients with ACS during PCI. 21 This investigation demonstrated that an intracoronary injection of nicorandil could further ameliorate the inflammatory and oxidative reactions in peripheral blood, which supported the need for a longer treatment period for nicorandil.…”

“… 20 On the other hand, ROS were generated and released after reperfusion because of damage of the mitochondrial respiratory chain. 21 The accumulation of ROS in the body caused oxidative damage, which may further aggravate MNR. 22 …”

Complex Coronary Instent Chronic Total Occlusion Lesions: Oxidative Stress, Inflammation, and Coronary Stent Lengths

“…Percutaneous coronary intervention (PCI) induces coronary injury on the endothelial cells which is related to the proinflammatory response and oxidative stress. PCI increases the levels of the inflammatory response and pathophysiological levels of oxidative stress response, which promotes the progression of coronary restenosis in patients with coronary artery disease after PCI [46,47]. Coronary atherosclerotic lesion formation is related to oxidative stress and inflammatory response.…”

Hypothesis: The potential therapeutic role of nicorandil in COVID‐19

“…52 The anti-inflammatory antioxidant property of nicorandil protected the coronary endothelial cell injury in patients undergoing percutaneous coronary intervention 53 and reduced the incidence of death following acute myocardial infarction. 54 In a direct cardiac tissue effect, nicorandil protected the heart against doxorubicin-induced cardiotoxicity. Nicorandil fixed the doxorubicin-impaired NO bioavailability and NF-kB activation and the resulted apoptosis and consequently improved cardiac functions and the myocardial histological picture.…”

“…The anti‐inflammatory antioxidant property of nicorandil protected the coronary endothelial cell injury in patients undergoing percutaneous coronary intervention 53 and reduced the incidence of death following acute myocardial infarction 54 . In a direct cardiac tissue effect, nicorandil protected the heart against doxorubicin‐induced cardiotoxicity.…”