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 |