Effects of intravenous nicorandil before reperfusion for acute myocardial infarction in patients with stress hyperglycemia.
OBJECTIVE
Stress hyperglycemia increases the risk of mortality and poor outcomes in patients with acute myocardial infarction (AMI). We aimed to assess effects of intravenous nicorandil administered before reperfusion on AMI patients with stress hyperglycemia.


METHODS
This study consisted of 158 consecutive first AMI patients with stress hyperglycemia who underwent percutaneous coronary intervention (PCI) within 24 h from the onset. They were randomly assigned to receive 12 mg of nicorandil (n = 81) or a placebo (n = 77) intravenously just before reperfusion. Stress hyperglycemia was defined as a blood glucose level > or =10 mmol/l (180 mg/dl). We examined various aspects of epicardial flow and microvascular function as immediate data and major adverse cardiac events (MACEs) (coronary heart disease death or unplanned readmission due to congestive heart failure) as late-phase data.


RESULTS
The incidence of slow flow after PCI was lower in the nicorandil group (13.6 vs. 27.3%, P < 0.04). ST segment resolution >50% was observed in 70.4 and 53.2% on nicorandil and placebo, respectively (P < 0.03). Patients treated with nicorandil had a lower peak creatine kinase level (3,137 +/- 2,577 vs. 4,333 +/- 3,608, P < 0.02). Upon Kaplan-Meier analysis, 5 years' freedom from MACEs was 86.4% in the nicorandil group and 74.0% in the placebo (P < 0.05).


CONCLUSIONS
Adjunctive therapy with administration of intravenous nicorandil before reperfusion on AMI patients with stress hyperglycemia significantly improves epicardial flow and prevents the occurrence of severe microvascular reperfusion injury, resulting in better outcomes in these patients.
Ishii
Hideki
H
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan. hkishii@med.nagoya-u.ac.jp
Ichimiya
Satoshi
S
Kanashiro
Masaaki
M
Amano
Tetsuya
T
Matsubara
Tatsuaki
T
Murohara
Toyoaki
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood; D048909:Diabetes Complications; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D020108:Nicorandil / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies
D001786:Blood Glucose; D002316:Cardiotonic Agents; D020108:Nicorandil; D003402:Creatine Kinase