Myocardial protective effect of intracoronary administration of nicorandil and alprostadil via targeted perfusion microcatheter in patients undergoing elective percutaneous coronary intervention

Abstract

Background: The aim of the study was to evaluate the efficacy of nicorandil and alprostadil on myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI). Methods: In this prospective, single-blinded, randomized controlled study, 90 consecutive patients scheduled for elective PCI for de novo coronary lesions were assigned to the nicorandil, alprostadil, and nitroglycerin groups in a 1:1:1 ratio. Drugs were administered intracoronary via a targeted perfusion microcatheter. The primary endpoint was the thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC). Additionally, the corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), and incidence of periprocedural myocardial injury (PMI) were assessed. Results: Both nicorandil and alprostadil were significantly effective in reducing TMPFC (114.6 ± 33.7 vs 93.4 ± 30.9, P = .016; 114.3 ± 34.3 vs 94.7 ± 33.3, P = .029, respectively). Similar findings were observed in the improvement of cTFC (20.3 ± 10.5 vs 13.5 ± 5.0, P = .003; 20.2 ± 7.4 vs 15.2 ± 5.2, P = .003, respectively) and percentage of TMPG 3 (100% vs 82.8%, P = .052; 83.3% vs 96.7%, P = .196, respectively); whereas, nitroglycerin produced a limited effect on TMPFC (114.4 ± 30.9 vs 112.1 ± 31.9, P = .739), cTFC (19.4 ± 7.2 vs 19.3 ± 7.2, P = .936), and percentage of TMPG 3 (86.7% vs 86.7%, P = 1.000). No significant difference was found in the incidence of PMI (16.7% vs 16.0% vs 27.6%, P = .537), though it was comparatively lower in the nicorandil and alprostadil groups. Furthermore, the intracoronary administration of nicorandil and alprostadil had a mild effect on blood pressure and heart rate. Conclusions: The intracoronary administration of nicorandil and alprostadil via a targeted perfusion microcatheter was more effective in improving myocardial perfusion in patients undergoing elective PCI than nitroglycerin.

Effects of Liposomal Prostaglandin E1 on Coronary Stenosis and Restenosis after Percutaneous Coronary Intervention: A Prospective Clinical Trial

“…A previous randomized controlled trial indicated that intracoronary administration of Nicorandil and PGE1 was more effective in improving myocardial perfusion than Nitroglycerin. 21 Another randomized-controlled study administered lipo-PGE1 at 20 µg/day diluted in 10 ml of NS through an intravenous injection over 5 min, starting at 3 days before PCI and continuing for 4 days after PCI. The results suggested that the cardioprotective effects of lipo-PGE1 were associated with its anti-inflammatory properties and its ability to improve microvascular perfusion.…”

KATP channels are regulators of programmed cell death and targets for the creation of novel drugs against ischemia/reperfusion cardiac injury

“…Nicorandil abolished homocysteine‐induced coronary MVO in mice [163]. It was reported that nicorandil reduced the incidence of MVO in patients with AMI and PCI [164–168].…”

Potential role of Chinese medicine nanoparticles to treat coronary artery disease

“…Lipid microsphere nanoparticles encapsulating alprostadil have been widely utilized in the treatment of myocardial infarction, angina, and other cardiovascular diseases. Alprostadil exerts inhibitory effects on platelet aggregation, promotes vasodilation to enhance microcirculation, dilates coronary arteries, and increases myocardial perfusion [ 19 ]. A randomized controlled trial involving 300 patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI) demonstrated that the combination of alprostadil and tanshinone IIa injection notably improved cardiac function and ventricular remodeling post-PCI, while also reducing the incidence of adverse events [ 20 ].…”