Cardiology Online

16th World Congress on Heart Disease

controversies meeting



Administration of Intravenous Nicorandil Before Reperfusion in Patients With St-Segment-Elevation Myocardial Infarction Leads to Beneficial Clinical Outcomes

August 30, 2005

By Sahar Bedrood B.S. and Asher Kimchi M.D.

Nagoya, Japan - Coronary reperfusion and percutanous coronary intervention are commonly performed for patients with acute myocardial infarction (AMI). The addition of pharmacological treatment can further ameliorate myocardial dysfunction. Recent clinical trials have shown that nicorandil, a hybrid of adenosine triphosphate–sensitive K channel opener and nitrates, exerts beneficial effects as an adjunctive therapy for patients with ischemic heart disease. A study done by Hideki Ishii, MD et al from Nagoya University in Japan observed the difference seen in patients who were treated with nicorandil prior to reperfusion therapy and in patients treated with placebo. The study, published in the August 30, 2005 issue of Circulation, found the addition of intravenous nicorandil to PCI leads to beneficial clinical outcomes and prevents cardiovascular events of long duration and death in patients with ST-segment–elevation myocardial infarction. 

This follow-up study to 5 years of a randomized, double-blinded trial was conducted among 368 patients with first ST-segment–elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). They were randomly assigned to receive 12 mg of nicorandil or a placebo intravenously just before reperfusion. The study analyzed incidence of cardiovascular death or rehospitalization for congestive heart failure after PCI as well as various aspects of epicardial flow and microvascular function. Mean follow-up was 2.4 years (SD, 1.4).  

A total of 12 (6.5%) patients receiving nicorandil and 30 (16.4%) receiving placebo had cardiovascular death or hospital admission for congestive heart failure (hazard ratio, 0.39; 95% CI, 0.20 to 0.76; P=0.0058). Postprocedural TIMI 3 flow was obtained in 89.7% of the nicorandil group and in 81.4% of the placebo (hazard ratio, 1.99; 95% CI, 1.09 to 3.65; P=0.025). Corrected TIMI frame count was furthermore lower in the nicorandil group (21.0±9.1 versus 25.1±14.1; P=0.0009). ST-segment resolution >50% was observed in 79.5% and 61.2% of the nicorandil and placebo groups, respectively (hazard ratio, 2.45; 95% CI, 1.54 to 3.90; P=0.0002). 

It was thus concluded from this study that patients receiving nicorandil have markedly lowered major complications with significantly better outcomes.  

Co-authors: Hideki Ishii, MD; Satoshi Ichimiya, MD, PhD; Masaaki Kanashiro, MD, PhD; Tetsuya Amano, MD, PhD; Kenji Imai, MD, PhD; Toyoaki Murohara, MD, PhD; Tatsuaki Matsubara, MD, PhD 


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