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

Abstract

Objective: Currently, there is still no effective strategy to diminish the infarct size (IS) in patients with ST-segment elevation myocardial infarction (STEMI). According to a previous animal study, nicorandil treatment is a promising pharmaceutical treatment to limit the infarct area. In this study, we aim to investigate the effects of continual nicorandil administration on the IS and the clinical outcomes in patients with STEMI who underwent primary percutaneous coronary intervention (pPCI). Methods: One hundred seventeen patients with STEMI and undergoing pPCI were randomly divided into the sustained nicorandil group (5 mg, three times daily) or the control group (only single nicorandil before PCI). The primary endpoint was the IS, evaluated by single-photon emission computed tomography (SPECT) 3 months after pPCI. Results: Eighty-five patients completed the IS assessment via SPECT, and 99 participants were available for follow-up after 6 months. Finally, there was a statistical difference in the IS between the nicorandil and control groups {13% [interquartile range (IQR), 8–17] versus 16% [IQR, 12–20.3], p=0.027}. Additionally, we observed that maintained nicorandil administration significantly improved the left ventricular ejection fraction at 3 months and enhanced the activity tolerance (physical limitation and angina stability) at 6 months after PCI. Conclusion: Sustained nicorandil treatment reduced the IS and improved the clinical outcomes compared to the single nicorandil administration for patients with STEMI undergoing the pPCI procedure. Continuous cardioprotective therapy may be more beneficial for patients with STEMI.

Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI

“…In recent years, elderly STEMI patients have been treated effectively after PCI with either tirofi ban, a nonpeptide antagonist of the platelet glycoprotein (GP) IIb/ IIIa receptor and an inhibitor of platelet aggregation, [13] or nicorandil, a vasodilator. [14] The early use of tirofi ban significantly improves myocardial perfusion after PCI, [15,16] and nicorandil has been shown to substantially diminish infarct size in STEMI patients undergoing PCI.…”

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

“…As previous studies have relatively approved the efficacy of chronic oral nicorandil administration in STEMI patients, we did not continue oral nicorandil administration during hospital stay and after discharge. 12,21,30 So, further large scale multicenter randomized control trials with long-term follow ups are recommended.…”

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

“…Investigators could not find the anti‐arrhythmic effect of nicorandil because patients received nicorandil at discharge but not before PCI. The use of nicorandil prior to and post PCI in patients with AMI decreased the incidence of ventricular arrhythmias [151]. Thus, in summary, most clinical data demonstrated that nicorandil did not exhibit a significant anti‐arrhythmic or proarrhythmic effect in patients with AMI.…”

“…Nicorandil reduced infarct size and prevented reperfusion arrhythmias in patients with AMI and reperfusion therapy [147, 151, 162].…”

“…Nicorandil reduced the troponin T and CK‐MB levels in patients with STEMI and PCI in comparison with the control group [172]. Nicorandil did not exhibit the pro‐arrhythmic effect in patients with AMI [71, 145, 147, 149] or did not prevent the appearance of reperfusion arrhythmias in patients with AMI [147, 151]. Pretreatment with nicorandil prevented the occurrence of the no‐reflow/slow flow phenomenon and microvascular obstruction in patients with AMI and PCI [147, 159–162].…”