Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials

Li Xu, Lefeng Wang, Kuibao Li, Zhiyong Zhang, Hao Sun, Xinchun Yang, Li Xu, Lefeng Wang, Kuibao Li, Zhiyong Zhang, Hao Sun, Xinchun Yang

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.

Keywords: Nicorandil; ST-segment elevated myocardial infarction; meta-analysis; no-reflow phenomenon; primary percutaneous coronary intervention.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of literature search and study identification. Abbreviations: PCI, percutaneous coronary intervention; STEMI, ST-segment elevated myocardial infarction.
Figure 2
Figure 2
Forest plots for the meta-analysis of the influences of nicorandil on coronary blood flow in STEMI patients undergoing primary PCI; (A) effects of nicorandil on the incidence of NRP; (B) effects of nicorandil on CTFC. Abbreviations: PCI, percutaneous coronary intervention; STEMI, ST-segment elevated myocardial infarction; NRP, no-reflow phenomenon; CTFC, corrected thrombolysis in myocardial infarction (TIMI) frame count.
Figure 3
Figure 3
Forest plots for the meta-analysis of the influences of nicorandil on wall motion and cardiac systolic function in STEMI patients undergoing primary PCI; (A) effects of nicorandil on WMS; (B) effects of nicorandil on LVEF. Abbreviations: PCI, percutaneous coronary intervention; STEMI, ST-segment elevated myocardial infarction; WMS, wall motion score; LVEF, left ventricular ejection fraction.
Figure 4
Figure 4
Forest plots for the meta-analysis of the influences of nicorandil on clinical outcomes in STEMI patients undergoing primary PCI; (A) effects of nicorandil on the risk of HF exacerbation or rehospitalization; (B) effects of nicorandil on the incidence of MACE. Abbreviations: PCI, percutaneous coronary intervention; STEMI, ST-segment elevated myocardial infarction; MACE, major adverse cardiovascular events; HF, heart failure.

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