title: Impact of nicorandil to prevent reperfusion injury in patients with acute myocardial infarction: Sigmart Multicenter Angioplasty Revascularization Trial (SMART).
abstract: BACKGROUND
  Nicorandil in conjunction with percutaneous coronary intervention (PCI) has been reported to reduce reperfusion injury events and improve cardiac function in patients with acute myocardial infarction (AMI). This multicenter study was undertaken to determine the effectiveness and optimal administration of nicorandil in AMI patients.
  
  
  RESULTS
  Ninety-two patients with first AMI were randomly assigned to 1 of 3 groups: intracoronary administration of nicorandil (Group A), combined intravenous and intracoronary administration of nicorandil (Group B), and no nicorandil administration (Group C). The primary endpoint was a composite of the incidence of reperfusion-induced arrhythmia, chest pain, and no-reflow/slow-reflow. The secondary endpoint was the combined rate of improvement in the Thrombolysis in Myocardial Infarction frame count (cTFC) and ST resolution (STR). A significant difference was observed in the primary endpoint for Group B as compared with Group C (p<0.05). In the meantime, a significant improvement was shown in the secondary endpoint for Group B compared with Group C (p=0.04 and 0.006 for cTFC and STR, respectively).
  
  
  CONCLUSIONS
  Combined intravenous and intracoronary administration of nicorandil reduces reperfusion injury during PCI and improves the cTFC and STR in AMI, and appears to be preferable to intracoronary administration alone.
authors.affiliation: First Department of Internal Medicine, Mie University School of Medicine, Japan. satoshio@clin.medic.mie-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ota
authors.forename: Hideo
authors.initials: H
authors.lastname: Nishikawa
authors.forename: Masaki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Kazuki
authors.initials: K
authors.lastname: Nakajima
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Nakamura
authors.forename: Shinya
authors.initials: S
authors.lastname: Okamoto
authors.forename: Morimichi
authors.initials: M
authors.lastname: Setsuda
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Makino
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yamakado
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakano
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D020108:Nicorandil; D020127:Recovery of Function / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D020108:Nicorandil