Nicorandil versus isosorbide dinitrate as adjunctive treatment to direct balloon angioplasty in acute myocardial infarction.
OBJECTIVE
To compare the effects of nicorandil (a hybrid ATP sensitive potassium channel (K+(ATP) channel) opener/nitric oxide donor) with those of isosorbide dinitrate (ISDN) on myocardial microcirculation and cardiac function in patients with acute myocardial infarction (AMI) who had undergone reperfusion treatment by direct balloon angioplasty.


METHODS
Double blind randomised study.


METHODS
60 patients with AMI in Killip class I.


METHODS
Patients were assigned into two treatment groups: a nicorandil group (n = 30) and an ISDN group (n = 30). Each drug was infused intravenously at 6 mg/h for 72 hours starting at admission and was administered directly to the treated coronary artery immediately after angioplasty.


RESULTS
Compared with ISDN, nicorandil more frequently caused recovery of ST segment elevation just after reperfusion (15 of 27 (55.5%) in the nicorandil group v 5 of 26 (19.2%) in the ISDN group, p = 0.006). The nicorandil group had higher values of averaged peak velocity 40 minutes after reperfusion (mean (SD) 24.8 (13.3) cm/s v 16.0 (11.1) cm/s, p = 0.045) and higher values of regional wall motion of the infarcted area three weeks after onset of AMI (-1.78 (1.11) v -2.50 (1.04) SD/chord, p = 0.046).


CONCLUSIONS
A combination of nicorandil drip infusion starting before reperfusion and intracoronary injection immediately after reperfusion is more effective than a similarly performed infusion of ISDN in preserving myocardial microcirculation in the reperfused AMI area. The nicorandil regimen resulted in better left ventricular regional wall motion.
Ikeda
N
N
Department of Integrated Medicine I, Omiya Medical Centre, Jichi Medical School, 1-847 Amanuma, Saitama, Saitama 330-8305, Japan.
Yasu
T
T
Kubo
N
N
Hashimoto
S
S
Tsuruya
Y
Y
Fujii
M
M
Kawakami
M
M
Saito
M
M
D000800:Angioplasty, Balloon / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D003326:Coronary Circulation / Q000187:drug effects; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D020108:Nicorandil / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D020108:Nicorandil; D007548:Isosorbide Dinitrate