Beneficial effects of intracoronary nicorandil on microvascular dysfunction after primary percutaneous coronary intervention: Demonstration of its superiority to nitroglycerin in a cross-over study

Noritoshi Ito, Shinsuke Nanto, Yasuji Doi, Yuma Kurozumi, Tomoaki Natsukawa, Hiroyuki Shibata, Masaya Morita, Atsushi Kawata, Ayumu Tsuruoka, Hirotaka Sawano, Ken Ichiro Okada, Yasuhiko Sakata, Tatsuro Kai, Toru Hayashi

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)

Abstract

Purpose: In patients undergoing primary percutaneous coronary intervention (PCI) for the treatment of ST-segment elevation myocardial infarction (STEMI), coronary microvascular dysfunction is associated with poor prognosis. Coronary microvascular resistance is predominantly regulated by ATP-sensitive potassium (KATP) channels. The aim of this study wasto clarify whether nicorandil, a hybrid KATP channel opener and nitric oxide donor, may be a good candidate for improving microvascular dysfunction even when administered after primary PCI. Methods: We compared the beneficial effects of nicorandil and nitroglycerin on microvascular function in 60 consecutive patients with STEMI. After primary PCI, all patients received single intracoronary administrations of nitroglycerin (250 μg) and nicorandil (2 mg) in a randomized order; 30 received nicorandil first, while the other 30 received nitroglycerin first. Microvascular dysfunction was evaluated with the index of microcirculatory resistance (IMR), defined as the distal coronary pressure multiplied by the hyperemic mean transit time. Results: As a first administration, nicorandil decreased IMR significantly more than did nitroglycerin (median [interquartile ranges]: 10.8[5.2-20.7] U vs. 2.1[1.0-6.0] U, p = 0.0002).As a second administration, nicorandil further decreased IMR, while nitroglycerin did not (median [interquartile ranges]: 6.0[1.3-12.7] U vs. -1.4[-2.6 to 1.3] U, p < 0.0001). The IMR after the second administration was significantly associated with myocardial blush grade, angiographic TIMI frame count after the procedure, and peak creatine kinase level. Conclusion: Intracoronary nicorandil reduced microvascular dysfunction after primary PCI more effectively than did nitroglycerin in patients with STEMI, probably via its KATP channel-opening effect.

Original languageEnglish
Pages (from-to)279-287
Number of pages9
JournalCardiovascular Drugs and Therapy
Volume27
Issue number4
DOIs
Publication statusPublished - 2013 Aug
Externally publishedYes

Keywords

  • Acute myocardial infarction
  • Coronary microvascular function
  • Microvascular dysfunction
  • Nicorandil
  • Nitroglycerin

ASJC Scopus subject areas

  • Pharmacology
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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