Preservation of myocardial viability within the risk area by intravenous nicorandil before primary coronary intervention in patients with acute myocardial infarction.
OBJECTIVE
To investigate the cardioprotective effect of intravenous nicorandil before primary percutaneous coronary intervention (PCI) on preservation of myocardial viability, we studied 199 consecutive patients with acute myocardial infarction.


METHODS
Nicorandil was given intravenously on admission (before primary PCI). Echocardiography and technetium-99m tetrofosmin perfusion imaging were performed before and 1 month after primary PCI. Echocardiographic asynergic score before primary PCI was used to define the size of risk area, whereas the sum of scintigraphic defect grade before primary PCI was used to estimate myocardial viability within the area at risk. The change (before primary PCI and 1 month after primary PCI) in asynergic score and scintigraphic salvage index were calculated.


RESULTS
Patients were divided into nicorandil (n=101) and control (n=98) groups. Although asynergic score before primary PCI was not different between the two groups (nicorandil=3.5+/-2.1 and control=3.9+/-1.5), myocardial viability was preserved in nicorandil group (defect score=11.0+/-4.0) than that in control group (defect score=14.0+/-4.7, P<0.0001). Multivariate analysis revealed that the presence of antegrade flow (P=0.015) and nicorandil (P<0.0001) were independently associated with preserved myocardial viability before primary PCI. Moreover, the greater reduction in asynergic score (66+/-41 vs. 49+/-23%, P=0.0006) and larger salvage index (65+/-25 vs. 53+/-26%, P=0.0015) were observed in nicorandil group compared with the control group.


CONCLUSIONS
Intravenous administration of nicorandil before primary PCI preserved myocardial viability within the risk area, which leads to greater myocardial salvage and better functional recovery after primary PCI.
The Second Department of Internal Medicine, Cardiovascular Centre, Kansai Medical University, Osaka, Japan.
Shigeo
S
Umemura
Seishi
S
Nakamura
Tetsuro
T
Sugiura
Yoshiaki
Y
Tsuka
Michio
M
Shimojo
Masato
M
Baden
Toshiji
T
Iwasaka
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D020108:Nicorandil / Q000008:administration & dosage / Q000627:therapeutic use*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D020108:Nicorandil; C078700:technetium tc-99m tetrofosmin