<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>

Abstract

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.

Nicorandil for Periprocedural Myocardial Injury in Elective Percutaneous Coronary Intervention: A Meta-Analysis of 10 Randomized Controlled Trials

“…Recently, several meta-analyses reported the cardioprotective effect of nicorandil in PCI 23 –28 ; however, differences should be noted between the present study and the previous studies. First, in terms of patients, Xu et al 27 and Li et al 28 involved patients requiring primary PCI, Ji et al 26 involved acute myocardial infarction patients requiring PCI, and Li et al 24 involved different kinds of CAD patients requiring PCI, although they declared that they retrieved SAP patients needing PCI. In contrast, we strictly selected patients undergoing elective PCI.…”

Intracoronary application of nicorandil regulates the inflammatory response induced by percutaneous coronary intervention

“…In recent years, many researchers have tried to use intravenous or intracoronary nicorandil to improve coronary microcirculation and myocardial perfusion during PCI and reduce myocardial ischaemia‐reperfusion injury. Nicorandil administration before PCI in patients with AMI can significantly improve coronary blood flow, reduce the occurrence of ventricular arrhythmias and improve left ventricular function . Although there is a lack of large‐scale, multi‐centre, double‐blind controlled clinical data, most clinical studies have shown that, compared with nitroglycerin, it can better correct coronary no‐reflow, increase myocardial perfusion and improve cardiac function.…”

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

“…For instance, the study by Ishii et al defined the MACE as the composite of all-cause mortality and all-cause admission,2 while Feng et al described the MACE as the composite of cardiovascular death or unplanned readmission due to worsening congestive heart failure (HF) 3. Moreover, Xu et al define the MACE in this meta-analysis as the composite outcomes of all-cause death, target vessel revascularization, recurrent angina or myocardial infarction, stroke and severe HF.1 In this situation, the study conducted by Fujiwara et al did not report the MACE events 4. Thus, Xu et al regarded the in-stent restenosis as the MACE event (in-stent restenosis occurred in 9 patients in the nicorandil group and 10 in the control group, respectively), which was the violation of the predefined protocol.…”

“…Recently, we read with great interest the study by Xu et al1 The authors performed a meta-analysis to evaluate the effectiveness of the administration of nicorandil during percutaneous coronary intervention in patients with acute myocardial infarction. They concluded that periprocedural nicorandil improves coronary blood flow, cardiac systolic function and prognosis in STEMI patients receiving primary PCI.…”

“…Secondly, Xu et al used the main adverse cardiac events (MACEs) as the hard points although the definition of MACE between the studies was not consistent 1. For instance, the study by Ishii et al defined the MACE as the composite of all-cause mortality and all-cause admission,2 while Feng et al described the MACE as the composite of cardiovascular death or unplanned readmission due to worsening congestive heart failure (HF) 3.…”