Nicorandil in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis

Muli Wu, Zheng Huang, Haojun Xie, Zhongjiang Zhou, Muli Wu, Zheng Huang, Haojun Xie, Zhongjiang Zhou

Abstract

Background: Nicorandil, as an adjunctive therapy with primary percutaneous coronary intervention (PCI), had controversial benefits in cardioprotection in patients with acute myocardial infarction (AMI).

Methods and results: We 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.

Conclusions: Nicorandil 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow Diagram for Inclusion of…
Figure 1. Flow Diagram for Inclusion of Studies in Meta-analysis.
The initial search identified 994 articles, of which, 14 trials were included in the final analysis. AMI = acute myocardial infarction; RCTs = randomized controlled trials.
Figure 2. Risk of Bias Summary.
Figure 2. Risk of Bias Summary.
Figure 3. Funnel Plot for the Incidence…
Figure 3. Funnel Plot for the Incidence of TIMI Flow Grade ≤ 2.
RR = risk ratio; SE = standard error.
Figure 4. RR of the Incidence of…
Figure 4. RR of the Incidence of TIMI Flow Grade ≤ 2.
Forest plot of RR (with 95% CI) for TIMI flow grade ≤ 2 in patients receiving nicorandil compared with those receiving no nicorandil. Significant reduction in TIMI flow grade ≤ 2 (RR: 0.57; 95% CI: 0.42 to 0.79; p=0.0006) was observed in nicorandil group. CI = confidence interval; RR = risk ratio; TIMI = thrombolysis in myocardial infarction.
Figure 5. MD of TIMI Frame Count.
Figure 5. MD of TIMI Frame Count.
Forest plot of MD (with 95% CI) for TIMI frame count in patients receiving nicorandil compared with those receiving no nicorandil. Significant reduction in TIMI frame count (MD: -5.19; 95% CI: -7.13 to -3.26; p

Figure 6. MD of LVEF.

Forest plot…

Figure 6. MD of LVEF.

Forest plot of MD (with 95% CI) for LVEF in…

Figure 6. MD of LVEF.
Forest plot of MD (with 95% CI) for LVEF in patients receiving nicorandil compared with those receiving no nicorandil. Significant increase in LVEF (MD: 3.08; 95% CI: 0.79 to 5.36; p=0.008) was observed in nicorandil group. CI = confidence interval; LVEF = left ventricular ejection fraction; MD = mean difference.
Figure 6. MD of LVEF.
Figure 6. MD of LVEF.
Forest plot of MD (with 95% CI) for LVEF in patients receiving nicorandil compared with those receiving no nicorandil. Significant increase in LVEF (MD: 3.08; 95% CI: 0.79 to 5.36; p=0.008) was observed in nicorandil group. CI = confidence interval; LVEF = left ventricular ejection fraction; MD = mean difference.

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