title: Evidence of pharmacologic preconditioning during PTCA by intravenous pretreatment with ATP-sensitive K+ channel opener nicorandil.
abstract: BACKGROUND
  It is not known whether pretreatment with nicorandil, an ATP-sensitive K+ channel (K(ATP)channel) opener, induces a preconditioning effect independent of increased collateral recruitment.
  
  
  METHODS
  Forty-four patients with angina who underwent percutaneous transluminal coronary angioplasty (PTCA) to proximal left anterior descending artery (LAD) stenosis were randomly allocated for pretreatment with an intravenous injection of 80 g/kg nicorandil 5 min before initial ballooning (n=22) or saline (n=22). 99mTc tetrofosmin was injected during balloon inflation, quantitative analysis of occlusion images by SPECT was conducted, and the defect severity score (SS) was calculated. An ECG was recorded during the 2-min inflation to calculate the sum of ST elevation (sigmaST).
  
  
  RESULTS
  SigmaST levels were significantly reduced in patients with nicorandil pretreatment compared with control patients (control:1.89+/-0.85 mV nicorandil:1.24+/-0.57 mV, p=0.0052). However, no difference was observed in defect severity (control: 79.0+/-32.5, nicorandil: 98.7+/-48.9 ns). A close correlation was observed between SS and sigmaST in both groups (nicorandil group R(2)=0.505, control group R(2)=0.599). A multivariate regression model demonstrated that both defect severity (p<0.0001) and pretreatment with nicorandil (p<0.001) were significantly related to the level of sigmaST, suggesting a cellular protective effect against ischaemia by nicorandil, independent of myocardial blood flow.
  
  
  CONCLUSIONS
  Nicorandil pretreatment resulted in the induction of myocardial preconditioning independent of the severity of ischaemia.
authors.affiliation: Gifu Prefectural Hospital, Gifu, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuo
authors.forename: Sachiro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Tomonori
authors.initials: T
authors.lastname: Segawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Yasuda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hirose
authors.forename: Makoto
authors.initials: M
authors.lastname: Iwama
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Takahiko
authors.initials: T
authors.lastname: Yamaki
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Matsuno
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tomita
authors.forename: Shinya
authors.initials: S
authors.lastname: Minatoguchi
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Fujiwara
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D002120:Calcium Channel Agonists / Q000627:therapeutic use*; D003097:Collateral Circulation; D023921:Coronary Stenosis / Q000628:therapy; D005260:Female; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D009204:Myocardial Revascularization; D020108:Nicorandil / Q000627:therapeutic use*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D002120:Calcium Channel Agonists; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D020108:Nicorandil; C078700:technetium tc-99m tetrofosmin