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Nicorandil prevents microvascular dysfunction resulting from PCI in patients with stable angina pectoris: a
Atsushi Hirohata1, Keizo Yamamoto, Eiki Hirose
1The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Insights
Nicorandil administration reduced microvascular dysfunction after percutaneous coronary intervention (PCI) in patients with stable angina. This treatment lowered the index of microcirculatory resistance (IMR) and cardiac troponin I (cTnI) levels post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Physiology
Background:
- Percutaneous coronary intervention (PCI) can induce microvascular dysfunction.
- Nicorandil, a potassium channel opener, may mitigate this dysfunction by dilating coronary resistance vessels.
Purpose of the Study:
- To evaluate the impact of intravenous nicorandil on the index of microcirculatory resistance (IMR) in patients with stable angina pectoris (SAP) undergoing PCI.
Main Methods:
- 62 patients with SAP undergoing PCI were randomized into control and nicorandil groups.
- Nicorandil was administered intravenously before and during PCI.
- Index of microcirculatory resistance (IMR) and cardiac troponin I (cTnI) were measured post-PCI.
Main Results:
- The nicorandil group showed significantly lower IMR and cTnI levels compared to the control group.
- The incidence of significant cTnI elevation was lower in the nicorandil group (12% vs. 41%).
- A weaker correlation between plaque reduction and cTnI elevation was observed in the nicorandil group.
Conclusions:
- Intravenous nicorandil administration reduces microvascular dysfunction following successful coronary stenting in stable angina patients.
- Nicorandil is associated with improved microcirculatory function and reduced myocardial injury post-PCI.
Aims:
Nicorandil, an ATP sensitive potassium channel opener, may reduce the incidence of microvascular dysfunction after percutaneous coronary intervention (PCI) by dilating coronary resistance vessels. The aim of the study was evaluation of the impact of the administration of intravenous nicorandil on measuring the index of microcirculatory resistance (IMR) in PCI to patients with stable angina pectoris (SAP).
Methods And Results:
Intravascular ultrasound (IVUS), fractional flow reserve (FFR), IMR and blood examination (CK-MB), cardiac troponin I (cTnI) immediately post-PCI (and 24 hours later) were performed in 62 consecutive patients with SAP undergoing PCI. FFR and IMR were measured simultaneously with a single coronary pressure wire. IMR was defined as Pd/coronary flow (or Pd* mean transit time) at peak hyperaemia. Patients were randomised to the control (n=29), or nicorandil group (n=33). In the nicorandil group, nicorandil was intravenously administered as a 6 mg bolus injection just before PCI and as a constant infusion at 6 mg/hour for 24 hours thereafter. All volumetric IVUS parameters and FFR were similar between the two groups both pre- and post-PCI. However, IMR immediately post-PCI and cTnI 24 hours post-PCI were significantly higher in the control group compared to the nicorandil group (IMR: 25.4±12.1 vs. 17.9±9.1 units, and cTnI: 0.21±0.13 vs. 0.12±0.08 ng/mL, for control vs. nicorandil). The incidence for cTnI elevation more than fivefold the normal range (>0.20 ng/mL) was significantly larger in the control group than in the nicorandil group (41% vs. 12%, p<0.01). Additionally, the control group showed a closer correlation between plaque volume reduction during stenting as assessed by volumetric IVUS, and cTnI elevation than the nicorandil group (r=0.55 vs. 0.42, p<0.001 for control vs. nicorandil).
Conclusions:
In patients undergoing successful coronary stenting for stable angina, administration of nicorandil is associated with reduced microvascular dysfunction induced by PCI.
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