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

Abstract

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.

Cardiovascular events associated with nicorandil administration prior to primary percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction: a systematic review and meta-analysis

“…The present results also expand on those of a prior metaanalysis of clinical trials evaluating the outcomes of nicorandil at the time of reperfusion therapy in patients with acute MI undergoing PCI [38]. The authors of that report found that administration of nicorandil at the time of reperfusion was associated with improved coronary reflow, suppression of ventricular arrhythmia, and improved left ventricular ejection fraction.…”

The role of gasotransmitters NO, H2S and CO in myocardial ischaemia/reperfusion injury and cardioprotection by preconditioning, postconditioning and remote conditioning

“…Nicorandil, a NO-donor and KATP channel opener, has been shown to reduce the infarct size in rabbit hearts (Argaud et al, 2009). However, a meta-analysis of available small-scale clinical trials could not show direct benefit in myocardial infarction patients from nicorandil treatment, possibly due to the lack of large clinical trials (Wu et al, 2013).There are several novel compounds with potential cardioprotective properties, whose mechanisms of action depend upon NO signalling. PostC with isoflurane decreases infarct size in wild-type mice.…”

Effect of Intracoronary Nitroprusside in Preventing No Reflow Phenomenon during Primary Percutaneous Coronary Intervention: A Meta‐Analysis

“…Some patients experienced transient hypotension for a short time, but prolonged hypotension was not noted, and the use of vasopressor or intra‐aortic balloon pump (IABP) during the procedure was also similar in both groups . Compared with drugs such as adenosine, verapamil, and nicorandil that have not yet been proved to be associated with conclusive improvements in clinical outcome, NTP would be a more promising adjuvant drug in the treatment of NR, and the possible mechanisms partly due to intracoronary NTP could produce an equivalent but more prolonged coronary hyperemia than adenosine or other drugs . There are also some limitations in the present study.…”