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Impact of oral nicorandil administration prior to primary percutaneous coronary intervention on no-reflow: a
Tarek Abdel-Hameed Nagib Ahmed1, Shimaa Sayed Khidr2, Ahmed Abdelnaser Abdelrady2
1Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut, 71526, Egypt. tarek.a.n.ahmed@med.aun.edu.eg.
Insights
Oral nicorandil administered before primary percutaneous coronary intervention significantly reduced no-reflow and major adverse cardiac events in STEMI patients. This treatment improved myocardial reperfusion and left ventricular function at 3 months.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Previous studies indicated cardioprotective effects of nicorandil via intravenous or intracoronary routes in ST-segment elevation myocardial infarction (STEMI).
- Limited data exists on the efficacy of oral nicorandil for STEMI, particularly given the limited availability of parenteral formulations.
Purpose of the Study:
- To evaluate the impact of oral nicorandil given before primary percutaneous coronary intervention (PPCI) on the incidence of no-reflow.
- To assess in-hospital and 3-month major adverse cardiac events (MACE) following PPCI.
Main Methods:
- A randomized controlled trial involving 302 STEMI patients undergoing PPCI.
- Patients were assigned to receive either pre-PPCI oral nicorandil (20 mg) with maintenance therapy or a placebo.
- Primary endpoint was no-reflow (TIMI flow ≤ 2); secondary endpoints included myocardial blush grade, ST-segment resolution, repolarization dispersion, and MACE.
Main Results:
- The nicorandil group exhibited significantly lower rates of no-reflow (11.9% vs. 24.5%, p=0.005) compared to the control group.
- Nicorandil administration was an independent predictor of reduced no-reflow (OR=0.43).
- Improved myocardial reperfusion, left ventricular function, and reduced MACE were observed in the nicorandil group at 3-month follow-up.
Conclusions:
- Oral nicorandil administration before PPCI effectively reduces no-reflow and enhances myocardial reperfusion in STEMI patients.
- The treatment is associated with improved left ventricular ejection fraction and a significant reduction in MACE at 3 months.
Background:
Prior studies and meta-analyses showed cardioprotective benefits of intravenous or intracoronary nicorandil administration in ST-segment elevation myocardial infarction (STEMI). However, little is known about the efficacy of oral nicorandil in this context, especially that parenteral forms are not widely available.
Aim:
To investigate the impact of oral nicorandil administered before primary percutaneous coronary intervention (PPCI) on no-reflow and to assess the in-hospital and 3-month major adverse cardiac events (MACE).
Methods:
A total of 302 patients with STEMI undergoing PPCI were randomly assigned in a 1:1 fashion to the Nicorandil-group, who received pre-PPCI oral nicorandil 20 mg followed by maintenance 20 mg b.i.d. for 3 months, and the Control-group. The primary endpoint was no-reflow defined as TIMI flow ≤ 2. Secondary endpoints included myocardial blush grade (MBG), ST-segment resolution, electrocardiographic repolarization dispersion, and in-hospital and 3-month MACE. Baseline and follow-up echocardiography were performed. A 3-month cardiac magnetic resonance (CMR) was performed in a subset of 50 patients.
Results:
Nicorandil-group showed significantly lower rates of no-reflow (11.9% vs 24.5%, p = 0.005), better MBG, higher rates of complete ST-resolution, and better indices of repolarization dispersion compared to the Control-group. Pre-PPCI nicorandil was among the independent protectors against no-reflow (OR = 0.43, 95%CI = 0.23-0.81, p = 0.01). The Nicorandil-group demonstrated significantly better LV function and lower MACE at follow-up. Three-month CMR data showed microvascular obstruction in two patients among the Control-group and none among the Nicorandil-group (p = 0.14).
Conclusion:
Oral nicorandil was associated with post-PPCI lower rates of no-reflow and improved myocardial reperfusion. Moreover, it showed improved LVEF and reduced MACE at 3 months.
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