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Sustained nicorandil administration reduces infarct size in ST-segment elevation myocardial infarction patients with primary percutaneous coronary intervention [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-57383 | DOI: 10.14744/AnatolJCardiol.2018.57383  

Sustained nicorandil administration reduces infarct size in ST-segment elevation myocardial infarction patients with primary percutaneous coronary intervention

Shanjie Wang1, Yu Duan1, Xinyu Feng1, Liang Liu3, Zhaofeng Shi4, Bo Wang1, Chenhai Xia1, Wanrong Man1, Haichang Wang2, Zhijing Zhao1, Dongdong Sun1
1Department Of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
2Department Of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
3Department Of Respiratory Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, China
4Department Of Traditional Chinese Medicine, Xijing Hospital Affiliated To Fourth Military Medical University, Xi’an, China

Objective: Currently, there is still no effective strategy to diminish infarct size for ST-segment elevation myocardial infarction (STEMI) patients. According to previous animal study, nicorandil treatment is a promising pharmaceutical treatment to limit infarct area. In this study, we aim to investigate the effects of continual nicorandil administration on infarct size and the clinical outcomes in STEMI patients with primary percutaneous coronary intervention (pPCI).
Methods: One hundred seventeen STEMI patients undergoing pPCI were randomly divided into the sustained nicorandil group (5 mg per time, three times daily) or the control group (only single nicorandil before PCI). The primary endpoint was the infarct size, evaluated by single-photon emission computed tomography (SPECT) 3 months after pPCI.
Results: Eighty-five patients completed the infarct size assessment via SPECT, and ninety-nine participants were available for follow-up after 6 months. Finally, there was a statistical difference in the infarct size (IS) between 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 month and enhanced activity tolerance (physical limitation and angina stability) at 6 months after PCI.
Conclusions: Sustained nicorandil treatment reduced infarct size and improved the clinical outcomes compared to the single nicorandil administration for STEMI patients receiving a pPCI procedure. Continual cardioprotective therapy may be more beneficial for STEMI patients.

Keywords: nicorandil, ST-segment elevation myocardial infarction, infarct size, percutaneous coronary intervention, single-photon emission computed tomography




Corresponding Author: Dongdong Sun, China


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