Intracoronary nicorandil prior to reperfusion in acute myocardial infarction.
BACKGROUND
A prospective, randomised, single centre study was designed to test the safety and efficacy of nicorandil infusion, a potassium channel opener, prior to reperfusion in ST-elevation acute myocardial infarction (STEMI).


RESULTS
Seventy STEMI patients with TIMI 0 to 2 flow were randomly assigned to nicorandil (Group N; n = 35) or control (Group C; n = 35) and underwent direct percutaneous coronary intervention (PCI). In Group N, 2 mg of nicorandil was infused directly into the infarct area prior to reperfusion. Incidence of anterior infarction was 60% in both groups. With nicorandil infusion, additional ST elevations without chest pain were observed for a few minutes in 94% of cases. However, no ventricular fibrillation or ventricular tachycardia occurred. TIMI myocardial perfusion grade 3 was significantly higher in Group N (40% vs. 17%, p<0.01). Patients were followed for up to 8 months, with similar incidence of major clinical adverse events, however left ventricular regional wall motion score significantly improved in Group N (P < 0.05). The effect of nicorandil was seen in patients without ischaemic preconditioning (P < 0.05).


CONCLUSIONS
This study suggests that direct infusion of nicorandil prior to revascularisation may be safe and beneficial.
Miyazawa
Akiyoshi
A
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Ikari
Yuji
Y
Tanabe
Kengo
K
Nakajima
Hiroyoshi
H
Aoki
Jiro
J
Iijima
Raisuke
R
Nakayama
Tomohiro
T
Hatori
Mitsuharu
M
Nakazawa
Gaku
G
Tanimoto
Shuzo
S
Onuma
Yoshinobu
Y
Hara
Kazuhiro
K