Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon

Kawai, Yusuke; Hisamatsu, Ken-ichi; Matsubara, Hiromi; Dan, Kazuhiro; Akagi, Satoshi; Miyaji, Kohei; Munemasa, Mitsuru; Fujimoto, Yoshihisa; Kusano, Kengo; Ohe, Tohru

doi:10.1093/eurheartj/ehp077

Cited by 46 publications

(25 citation statements)

References 26 publications

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“…Table 1 summarized the baseline characteristics, and Table 2 summarized the intervention characteristics of the included trials. One trial [22] was published in abstract, one [15] was a subgroup analysis, and remaining 12 trials have full-text publication. All trials included patients with ST-segment elevation myocardial infarction (STEMI) but one [20] did not report.…”

Section: Resultsmentioning

confidence: 99%

Nicorandil in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Zheng

Xie

et al. 2013

PLoS ONE

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BackgroundNicorandil, as an adjunctive therapy with primary percutaneous coronary intervention (PCI), had controversial benefits in cardioprotection in patients with acute myocardial infarction (AMI).Methods and ResultsWe performed a systematic review of randomized controlled trials (RCTs) comparing treatment with nicorandil prior to reperfusion therapy with control (placebo or no nicorandil) in patients who suffered from AMI and performed primary PCI. PubMed, EMBASE and CENTRAL databases and other sources were searched without language and publication restriction. 14 trials involving 1680 patients were included into this meta-analysis. Nicorandil significantly reduced the incidence of thrombolysis in myocardial infarction (TIMI) flow grade ≤2 (risk ratio [RR], 0.57; 95% confidence interval [CI]: 0.42 to 0.79), the Timi frame count (TFC) (mean difference [MD], -5.19; 95% CI: -7.13 to -3.26), increased left ventricular ejection fraction (LVEF) (%) (MD, 3.08; 95% CI: 0.79 to 5.36), and reduced the incidence of ventricular arrhythmia (RR, 0.53; 95% CI: 0.37 to 0.76) and congestive heart failure (CHF) (RR, 0.41; 95% CI: 0.22 to 0.75). No difference in the pear creatine kinase (CK) value (MD, -290.19; 95% CI: -793.75 to 213.36) or cardiac death (RR, 0.39; 95% CI: 0.09 to 1.67) was observed.ConclusionsNicorandil prior to reperfusion is associated with improvement of coronary reflow as well as suppression of ventricular arrhythmia, and further improves left ventricular function in patients who suffered from AMI and underwent primary PCI. But the definite clinical benefits of nicorandil were not found, which may be due to the small sample size of the selected studies.

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Section: Resultsmentioning

confidence: 99%

Nicorandil in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Zheng

Xie

et al. 2013

PLoS ONE

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“…Furthermore, nicorandil can antagonize ADP induced platelet aggregation, improve microcirculation in ischemia area, decrease no reflow phenomenon. In addition, nicorandil can inhibit the formation of active oxygen, which is one of the mechanisms implicated in the protective effect on the myocardium51.…”

Section: Discussionmentioning

confidence: 99%

The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis

2017

Sci Rep

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Many scholars have studied the effect of nicorandil on perioperative myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI), but results are inconsistent. Therefore, we performed this meta-analysis. Finally, 16 articles, including 1616 patients, were included into this meta-analysis. Meta-analysis results showed that: (1) Nicorandil can reduce the level of CK-MB after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (2) Nicorandil can reduce the level of TnT after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (3) Nicorandil can reduce the incidence of adverse reactions after PCI. (4) Nicorandil cannot reduce the level of MVP after PCI, including at 12 hours and 24 hours. (5) Subgroup analysis showed that nicorandil can reduce CK-MB and TnT level at 24 hours after PCI for Chinese’s population (P < 0.05), but can not reduce CK-MB and TnT level at 24 hours after PCI for non Chinese’s population (P > 0.05). Our meta-analysis indicate that nicorandil can reduce myocardial injury and reduce the incidence of adverse reaction caused by PCI for Chinese’s population, but is not obvious for non Chinese’s population. However, this conclusion still needs to be confirmed in the future.

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“…31,32) The ischemic preconditioning effect of nicorandil is a well-accepted mechanism for myocardial protection during PCI and leads to the prevention of heart failure in PPCI and long-term improvement of mortality and CV death. 33,34) Our meta-analysis also demonstrated the benefits of nicorandil in reducing total mortality, CV death and heart failure in patients undergoing PPCI based on the low to moderate quality of evidence of outcomes.…”

Section: Discussionmentioning

confidence: 70%

Effects of Nicorandil on All-Cause Mortality and Cardiac Events in CAD Patients Receiving PCI

Zhang

Yao

et al. 2019

Int. Heart J.

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Current studies demonstrating the effects of nicorandil in the prognosis of coronary artery disease (CAD) patients who received percutaneous coronary intervention (PCI) are inconclusive due to the small sample size and small events rate. PubMed, OVID, CBM and CNKI databases were searched using a pre-specified search string to collect randomized controlled trials (RCTs) studying the effects of nicorandil on CAD patients receiving PCI. Data on all-cause mortality and cardiovascular events were collected. RevMan 5.3 software was used for meta-analysis. Subgroup analysis was conducted in patients receiving primary PCI (PPCI) and elective PCI (EPCI). A total of 18 RCTs were included in our final analysis. Nicorandil treatment significantly reduced total mortality in PPCI (Peto OR = 0.44, 95%CI 0.25-0.79, P = 0.006) and EPCI (Peto OR = 0.41, 95%CI 0.25-0.67, P = 0.0004), cardiovascular death in both PPCI (Peto OR = 0.41, 95%CI 0.20-0.84, P = 0.01) and EPCI (Peto OR = 0.40, 95%CI 0.20-0.80, P = 0.009), and heart failure in PPCI (RR = 0.36, 95%CI 0.22-0.59, P < 0.0001). When compared with placebo plus standard treatment or standard treatment alone, nicorandil plus standard treatment was associated with reduced total mortality in both PPCI and EPCI, CV death in EPCI, and heart failure in PPCI. Nicorandil is associated with lower risks of total mortality and CV death in PPCI and EPCI in those who received nicorandil > 28 days. Nicorandil as an adjunct therapy along with PCI is associated with reduced total mortality and cardiovascular death in PPCI and EPCI patients, and reduced heart failure in PPCI patients.

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Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon

Abstract: Our simple procedure prevented SCF phenomenon not only in patients with ACS but also in patients with non-ACS without any adverse effect. Additionally our procedure reduced the rate of TVR in patients with ACS.

Cited by 46 publications

References 26 publications

Nicorandil in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Nicorandil in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis

Effects of Nicorandil on All-Cause Mortality and Cardiac Events in CAD Patients Receiving PCI

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