Effect of nicorandil administration on myocardial microcirculation during primary percutaneous coronary intervention in patients with acute myocardial infarction

Chunguang Feng, Bing Han, Yi Liu, Lulu Wang, Dongdong Niu, Ming Lou, Cunzhi Lu, Chunguang Feng, Bing Han, Yi Liu, Lulu Wang, Dongdong Niu, Ming Lou, Cunzhi Lu

Abstract

Introduction: Prevention of the no-reflow phenomenon has a crucial role in primary percutaneous coronary intervention (P-PCI) procedures.

Aim: To assess the effects of early intracoronary administration of nicorandil (NIC) during P-PCI on myocardial microcirculation in patients with acute myocardial infarction (AMI).

Material and methods: A total of 120 patients with first acute anterior wall ST segment elevation myocardial infarction who underwent P-PCI were randomly divided into two groups: the NIC group (A, n = 60) and the placebo group (B, n = 60). Before stent placement, NIC or normal saline was injected using a guiding catheter. The thrombolysis in myocardial infarction (TIMI) grade, TIMI myocardial perfusion grade (TMPG), resolution of ST segment elevation (defined as > 50% decrease in ST elevation) 1 h after surgery, and 99Tcm-methoxyisobutyl isocyanide (MIBI) rest myocardial perfusion imaging (MPI) via single-photon emission computed tomography (99Tcm-MIBI SPECT) findings 10 days after surgery were compared between the two groups.

Results: The number of patients who achieved TIMI grade 3 (96.67% vs. 86.67%; p = 0.047) and TMPG 3 (95% vs. 83.33%; p = 0.040) was higher in the NIC group than in the placebo group. Resolution of ST segment elevation occurred in 95% and 81.67% of the patients in the NIC and placebo groups, respectively (p = 0.023); the MPI score of the two groups was 4.1 ±1.89 and 7.3 ±2.65, respectively (p = 0.014).

Conclusions: Early coronary administration of NIC can significantly reduce the damage in the myocardial microcirculation caused by P-PCI and the myocardial infarct size in patients with AMI.

Keywords: nicorandil; no-reflow; primary percutaneous coronary intervention.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of this trial
Figure 2
Figure 2
Comparison of target blood vessel TIMI grade 3 blood flow between the two groups. Significant improvement of target blood vessel TIMI grade 3 blood flow occurred in nicorandil group compared with placebo group

References

    1. Kloner RA. Does reperfusion injury exist in humans? J Am Coll Cardiol. 1993;21:537–45.
    1. Resnic FS, Wainstein M, Lee MK, et al. No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J. 2003;145:42–6.
    1. Morishima I, Sone T, Okumura K, et al. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol. 2000;36:1202–9.
    1. Taira N. Nicorandil as a hybrid between nitrates and potassium channel activators. Am J Cardiol. 1989;63:18J–24J.
    1. Treese N, Erbel R, Meyer J. Acute hemodynamic effects of nicorandil in coronary artery disease. J Cardiovasc Pharmacol. 1992;20(Suppl 3):S52–6.
    1. Abu Arab T, Rafik R, EI Etriby A. Efficacy and safety of local intracoronary drug delivery in treatment of no-reflow phenomenon: a pilot study. J Interv Cardiol. 2016;29:496–504.
    1. Wang L, Cheng Z, Gu Y, et al. Short-term effects of verapamil and diltiazem in the treatment of no reflow phenomenon: a meta-analysis of randomized controlled trials. Biomed Res Int. 2015;2015:382086.
    1. Yang L, Mu L, Sun L, et al. Effect of intracoronary nitroprusside injection on flow recovery during primary PCI in acute STEMI patients. Minerva Cardioangiol. 2017;65:111–8.
    1. Rezkalla SH, Stankowski RV, Hanna J, et al. Management of no-reflow phenomenon in the catheterization laboratory. JACC Cardiovasc Interv. 2017;10:215–23.
    1. Study S, Schmid JP, Schroeder V, et al. Comparison of the antiischaemic and antianginal effect of nicorandil and amlodipine in patients with symptomatic stable angina pectoris: the SWAN study. J Clin Basic Cardiol. 1999;14:213–7.
    1. Kobatake R, Sato T, Fujiwara Y, et al. Comparison of the effects of nitroprusside versus nicorandil on the slow/no-reflow phenomenonduring coronary interventions for acute myocardial infarction. Heart Vessels. 2011;26:379–84.
    1. Maruyama A, Hasegawa S, Paul AK, et al. Myocardial viability assessment with gated SPECT Tc-99m tetrofosmin % wall thickening: comparison with F-18 FDG-PET. Ann Nucl Med. 2002;16:25–32.
    1. Al Moudi M, Sun ZH. Diagnostic value of (18)F-FDG PET in the assessment of myocardial viability in coronary artery disease: a comparative study with (99m)Tc SPECT and echocardiography. J Geriatr Cardiol. 2014;11:229–36.
    1. Tsai JP, Yun CH, Wu TH, et al. A meta-analysis comparing SPECT with PET for the assessment of myocardial viability in patients with coronary artery disease. Nucl Med Commun. 2014;35:947–54.
    1. Rubeaux M, Xu Y, Germano G, et al. Normal databases for the relative quantification of myocardial perfusion. Curr Cardiovasc Imaging Rep. 2016;9:22.
    1. Reffelmann T, Kloner RA. The no-reflow phenomenon: basic science and clinical correlates. Heart. 2002;87:162–8.
    1. Gibson CM, Cannon CP, Piana RN, et al. Relationship of coronary flow to myocardial infarction size: two sample methods to subclassify TIMI flow grades. Circulation. 1992;86:1–453.
    1. Gibson CM, Cannon CP, Murphy SA, et al. Relationship of TIMI myocardial perfusion grade to mortality after administraion of thrombolytic drugs. Circulation. 2000;101:125–30.
    1. Tomaszuk-Kazberuk A, Musiał WJ, Dobrzycki S, et al. Normalisation of elevated ST segment predicts return of left ventricular systolic function and improved outcome in patients with acute myocardial infarction, treated with primary coronary angioplasty. Kardiol Pol. 2004;60:541–9.
    1. Kolh P, Windecker S, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur J Cardiothorac Surg. 2014;46:517–92.
    1. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med. 1997;336:1621–8.
    1. Yu J, Oh PC, Kim M, et al. Improved early risk stratification of patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention using a combination of serum soluble ST2 and NT-proBNP. PLoS One. 2017;12:e0182829.
    1. Polimeni A, De Rosa S, Sabatino J, et al. Impact of intracoronary adenosine administration during primary PCI: a meta-analysis. Int J Cardiol. 2016;203:1032–41.
    1. Campo G, Pavasini R, Morciano G, et al. Data on administration of cyclosporine, nicorandil, metoprolol on reperfusion related outcomes in ST-segment elevation myocardial infarction treated with percutaneous coronary intervention. Data Brief. 2017;14:197–205.
    1. Lee HC, An SG, Choi JH, et al. Effect of intra-coronary nicorandil administration prior to reperfusion in acute ST segment elevation myocardial infarction. Circ J. 2008;72:1425–9.
    1. Wu M, Huang Z, Xie H, et al. Nicorandil in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis. PLoS One. 2013;8:e78231.
    1. Chen C, Fu X, Li W, et al. Intracoronary administration of anisodamine and nicorandil in individuals undergoing primary percutaneous coronary intervention for acute inferior myocardial infarction: a randomized factorial trial. Exp Ther Med. 2015;10:1059–65.
    1. Campo G, Pavasini R, Morciano G, et al. Clinical benefit of drugs targeting mitochondrial function as an adjunct to reperfusion in ST-segment elevation myocardial infarction: a meta-analysis of randomized clinical trials. Int J Cardiol. 2017;244:59–66.
    1. Campo G, Morciano G, Pavasini R, et al. Fo ATP synthase C subunit serum levels in patients with ST-segment elevation myocardial infarction: preliminary findings. Int J Cardiol. 2016;221:993–7.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅