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Updated: Jan 28, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Sustained nicorandil administration reduces the infarct size in ST-segment elevation myocardial infarction patients
Shanjie Wang, Yu Duan, Xinyu Feng
1Department of Cardiology, Xijing Hospital, Fourth Military Medical University; Xi'an-China. wintersun3@gmail.com.
Insights
Sustained nicorandil treatment significantly reduced infarct size in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). This approach also improved cardiac function and patient activity tolerance post-procedure.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- ST-segment elevation myocardial infarction (STEMI) lacks effective strategies to reduce infarct size (IS).
- Previous animal studies suggest nicorandil may limit myocardial infarct area.
- Primary percutaneous coronary intervention (pPCI) is a standard treatment for STEMI.
Purpose of the Study:
- To investigate the effect of sustained nicorandil administration on infarct size (IS).
- To evaluate the impact of continuous nicorandil treatment on clinical outcomes in STEMI patients undergoing pPCI.
Main Methods:
- 117 STEMI patients undergoing pPCI were randomized into sustained nicorandil or control groups.
- Sustained nicorandil group received 5 mg thrice daily; control group received a single dose before PCI.
- Primary endpoint was IS assessed by SPECT at 3 months post-pPCI.
Main Results:
- A statistically significant reduction in IS was observed in the nicorandil group (13%) compared to the control group (16%) (p=0.027).
- Sustained nicorandil administration improved left ventricular ejection fraction at 3 months.
- Enhanced activity tolerance, including physical limitation and angina stability, was noted at 6 months.
Conclusions:
- Sustained nicorandil treatment is superior to single-dose administration for reducing IS in STEMI patients undergoing pPCI.
- Continuous cardioprotective therapy with nicorandil demonstrates significant clinical benefits.
- Nicorandil represents a promising therapeutic option for improving outcomes in STEMI patients.
Objective:
Currently, there is still no effective strategy to diminish the infarct size (IS) in patients with ST-segment elevation myocardial infarction (STEMI). According to a previous animal study, nicorandil treatment is a promising pharmaceutical treatment to limit the infarct area. In this study, we aim to investigate the effects of continual nicorandil administration on the IS and the clinical outcomes in patients with STEMI who underwent primary percutaneous coronary intervention (pPCI).
Methods:
One hundred seventeen patients with STEMI and undergoing pPCI were randomly divided into the sustained nicorandil group (5 mg, three times daily) or the control group (only single nicorandil before PCI). The primary endpoint was the IS, evaluated by single-photon emission computed tomography (SPECT) 3 months after pPCI.
Results:
Eighty-five patients completed the IS assessment via SPECT, and 99 participants were available for follow-up after 6 months. Finally, there was a statistical difference in the IS between the nicorandil and control groups {13% [interquartile range (IQR), 8-17] versus 16% [IQR, 12-20.3], p=0.027}. Additionally, we observed that maintained nicorandil administration significantly improved the left ventricular ejection fraction at 3 months and enhanced the activity tolerance (physical limitation and angina stability) at 6 months after PCI.
Conclusion:
Sustained nicorandil treatment reduced the IS and improved the clinical outcomes compared to the single nicorandil administration for patients with STEMI undergoing the pPCI procedure. Continuous cardioprotective therapy may be more beneficial for patients with STEMI.
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