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An, Park, Hwang, Choi, Lee, Lee, Kim, Kim, Chun, Hong, and Shin: The Effect of Intra-coronary Nicorandil Prior to Reperfusion in Acute ST Segment Elevation Myocardial Infarction
Original Article
Korean Circulation Journal

Korean Circulation Journal 2008; 38(2): 95-100.

Published online: 29 February 2008

DOI: https://doi.org/10.4070/kcj.2008.38.2.95

The Effect of Intra-coronary Nicorandil Prior to Reperfusion in Acute ST Segment Elevation Myocardial Infarction

Sung Gyu An, MD, Tae Ik Park, MD, Ki Won Hwang, MD, Jae-Hoon Choi, MD, Tae Kun Lee, MD, Han Cheol Lee, MD, Jun Kim, MD, June Hong Kim, MD, Kook Jin Chun, MD, Taek Jong Hong, MD, Yung Woo Shin, MD

Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea.

Correspondence: Han Cheol Lee, MD, Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, 10 Ami-dong 1-ga, Seo-gu, Busan 602-739, Korea. Tel: 82-51-240-7217, Fax: 82-51-240-7796, glaraone@hanmail.net

Received 16 August 2007       Revised 4 September 2007       Accepted 14 September 2007

Copyright © 2008 The Korean Society of Cardiology

Abstract

Background and Objectives

Intravenous nicorandil infusion with percutaneous coronary intervention (PCI) has been reported to reduce reperfusion injury events and to improve cardiac function in patients with an acute myocardial infarction. However, there is limited information on the use of intra-coronary nicorandil. A prospective randomized single center study was designed to evaluate the efficacy of the use of intra-coronary nicorandil.

Subjects and Methods

Seventy-three patients with an acute ST segment elevation myocardial infarction were randomly assigned to the nicorandil group (n=37) or a control group (n=36); all patients received a PCI. In the nicorandil group of patients, 4 mg of intra-coronary nicorandil was infused directly into the infarct area prior to reperfusion (2 mg before ballooning, 2 mg before stenting). The composite endpoint was the incidence of ventricular arrhythmia, no-reflow and slow flow. We estimated the post thrombolysis in myocardial infarction (TIMI) grade, the myocardial perfusion grade after PCI and the short-term clinical outcome.

Results

The baseline characteristics were similar in both groups of patients. A significant difference was observed in the composite endpoint in the nicorandil group of patients as compared to the control group of patients (p=0.037). The achievement rate of post TIMI grade 3 was significantly higher in the nicorandil group of patients (p=0.019). The myocardial perfusion grade 1 was not observed in the nicorandil group of patients; however, it was observed in five patients in the control group (p=0.019). Major adverse cardiac events in hospital and in 30 days were similar between the two groups.

Conclusion

Intra-coronary nicorandil infusion reduced the occurrence of no-reflow, slow reflow, reperfusion arrhythmia and improved the myocardial perfusion grade and TIMI flow during PCI. The results of this study showed that the use of intracoronary nicorandil improved the clinical outcome in patients with an acute myocardial infarction.

Keywords: Myocardial Infarction, Nicorandil, No-reflow phenomenon

Figures and Tables

Table 1
Baseline clinical characteristics
kcj-38-95-i001

MI: myocardial infacrtion, ACEI: angiotensin converting enzyme inhibitor, ARB: angiotension receptor blocker

Table 2
Angiographic characteristics
kcj-38-95-i002

LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery, ACC-AHA: American College of Cardiology/American Heart Association, TIMI: thrombolysis in myocardial infarction

Table 3
PCI data and Laboratory findings
kcj-38-95-i003

*p<0.05. PCI: percutaneous coronary intervention, CK-MB: creatine kinase-MB, PTCA: percutaneous transluminal coronary angioplasty, TIMI: thrombolysis in myocardial infarction

Table 4
Clinical outcomes
kcj-38-95-i004

TLR: target lesion revascularization, MI: myocardial infacrtion, VT: ventricular tachycardia, VF: ventricular fibrillation

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