Impacts of nicorandil on infarct myocardium in comparison with nitrate: assessed by cardiac magnetic resonance imaging

Abstract

In this pilot study, we compared the infarct and edema size in acute myocardial infarction (MI) patients treated by nicorandil with those treated by nitrate, using cardiac magnetic resonance (CMR) imaging. Fifty-two acute MI patients who underwent emergency percutaneous coronary intervention (PCI) were enrolled, and were assigned to receive nicorandil or nitrate at random just before reperfusion. For the assessment of infarct and edema areas, short-axis delayed enhancement (DE) and T2-weight (T2w) CMR images were acquired 6.1 ± 2.4 days after the onset of MI. A significant correlation was observed between the peak creatinine kinase (CK) level and the infarct size on DE CMR (r = 0.62, p < 0.05), as well as the edema size on T2w CMR (r = 0.70, p < 0.05) in patients treated by nicorandil (28 patients). A similar correlation was seen between the peak CK level and the infarct size on DE CMR (r = 0.84, p < 0.05), as well as the edema size on T2w CMR (r = 0.84, p < 0.05) in patients treated by nitrate (24 patients). The maximum CK level was significantly lower in patients treated by nicorandil rather than nitrate (1991 ± 1402, 2785 ± 2121 IU/L, respectively, p = 0.03). Both the edema size on T2w CMR and the infarct size on DE CMR were significantly smaller in patients treated by nicorandil rather than nitrate (17.7 ± 9.9, 21.9 ± 13.7 %; p = 0.03, 10.3 ± 6.0, 12.7 ± 6.9 %, p = 0.03, respectively). The presence and amount of microvascular obstruction were significantly smaller in patients treated by nicorandil rather than nitrate (39.2, 64.7 %; p = 0.03; 2.2 ± 1.3, 3.4 ± 1.5 cm(2); p = 0.02, respectively). Using CMR imaging, we demonstrated that the complementary use of intravenously and intracoronary administered nicorandil during PCI favorably acts more on the damaged myocardium after MI than nitrate. We need a further powered prospective study on the use of nicorandil.

The impact of oral nicorandil pre-treatment on ST resolution and clinical outcome of patients with acute ST-segment elevation myocardial infarction undergoing primary coronary angioplasty: A randomized placebo controlled trial

“…This finding is in contrary to those found in the most of previous studies where the drug was used through either intravenous or intracoronary route. [6][7][8][9]13,14 Also, in the present study, oral nicorandil did not have any effect on infarct size reduction and left ventricular function as evident by similar peak cardiac troponin and left ventricular ejection fraction (Table 1) . These findings are consistent with those reported by Kitakaze et al, who showed the intravenous nicorandil with no effect on either infarct size or left ventricular function.…”

Sustained nicorandil administration reduces infarct size in ST-segment elevation myocardial infarction patients with primary percutaneous coronary intervention

“…Unexpectedly, nicorandil could not decrease the IS assessed by creatine kinase compared to the placebo. Another small study performed by Yamada et al (16) enrolled 55 patients with AMI undergoing pPCI and administered intracoronary nicorandil or nitrate for 4 days. Their data revealed that nicorandil reduced IS by 18.9% compared with nitrate.…”

“…However, it is still controversial whether nicorandil diminishes IS in patients with acute myocardial infarct (15). Indeed, nicorandil was mostly administered a short time before PCI or during the perioperative period in previous trials (15, 16). However, microvascular obstruction would still deteriorate continuously after pPCI, and myocardial stunning may require several days or weeks to recover (10, 17).…”

Does Periprocedural Nicorandil Improve Cardiovascular Outcomes in Acute Myocardial Infarction? - Meta-Analysis

“…Seven of the thirteen studies assessed the post PCI TIMI flow grade in each of the study groups (Kitakaze M 9,13,14,16,18,21,22 Meta-analysis of this particular outcome showed that there was a significant difference in the TIMI flow grade between the Nicorandil and control groups. This was similar to the earlier two metaanalysis (Wu M et al and Iwakura K et al) 8,23 that clearly showed the superiority of Nicorandil over control in improving the post-PCI TIMI flow grade.…”

“…Some of the characteristics that were not reported in the baseline data could play a strong confounding role in influencing the outcome. For example, (Yamada K et al) 14 did not report the baseline CMR imaging between the groups. Although, small operator experience could also have a considerable impact on the outcomes.…”