title: Effects of oral nicorandil therapy on sympathetic nerve activity and cardiac events in patients with chronic heart failure: subanalysis of our previous report using propensity score matching.
abstract: OBJECTIVE
  Nicorandil, an adenosine triphosphate-sensitive potassium channel opener, improves cardiac sympathetic nerve activity (CSNA) in patients with ischaemic heart disease. However, the long-term effects on both CSNA, as evaluated by (123)I-metaiodobenzylguanidine (MIBG) scintigraphy, and prognosis have not been determined in patients with chronic heart failure (CHF).
  
  
  METHODS
  This study was a subanalysis of our previous results that serial (123)I-MIBG scintigraphic studies are the most useful prognostic indicator in CHF patients. The study group comprised 208 patients with CHF (left ventricular ejection fraction <45 %) but no cardiac events for at least 5 months identified on the basis of a history of decompensated acute heart failure requiring hospitalization. These patients underwent (123)I-MIBG scintigraphy and echocardiography just before leaving the hospital and again 6 months later. We selected 170 patients and used propensity propensity score matching to compare patients who received oral nicorandil (85 patients) and those who did not (85 patients). The patients were followed up for a median of 5.03 years, with the primary and secondary study end-points defined as the occurrence of a fatal cardiac event and a major adverse cardiac event (MACE), respectively.
  
  
  RESULTS
  After treatment, the extent of changes in (123)I-MIBG scintigraphic and echocardiographic parameters in the nicorandil group were more favourable than in those not receiving nicorandil. Of the 170 patients, a fatal cardiac event occurred in 42, and a MACE in 68 during the study. Multivariate Cox regression analyses revealed that no nicorandil treatment was a significant predictor of both cardiac death and MACE in our patients with CHF. On Kaplan-Meier analysis, the rates of freedom from cardiac death or from MACE in the nicorandil group were significantly higher than in those not receiving nicorandil (all p<0.05).
  
  
  CONCLUSIONS
  Long-term nicorandil treatment improves CSNA and left ventricular parameters in patients with CHF. Furthermore, this agent is potentially effective for reducing the incidence of cardiac events in patients with CHF.
authors: Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma, 371-0034, Japan, s-kasama@bay.wind.ne.jp.
authors: Shu
authors: S
authors: Kasama
authors: Takuji
authors: T
authors: Toyama
authors: Toshiya
authors: T
authors: Iwasaki
authors: Hiroyuki
authors: H
authors: Sumino
authors: Hisao
authors: H
authors: Kumakura
authors: Kazutomo
authors: K
authors: Minami
authors: Shuichi
authors: S
authors: Ichikawa
authors: Naoya
authors: N
authors: Matsumoto
authors: Yuichi
authors: Y
authors: Sato
authors: Masahiko
authors: M
authors: Kurabayashi
mesh_terms: D019797:3-Iodobenzylguanidine; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003643:Death; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020108:Nicorandil / Q000008:administration & dosage* / Q000494:pharmacology* / Q000627:therapeutic use; D009929:Organ Size / Q000187:drug effects; D011379:Prognosis; D011877:Radionuclide Imaging; D013564:Sympathetic Nervous System / Q000187:drug effects* / Q000503:physiopathology*
chemical_list: D020108:Nicorandil; D019797:3-Iodobenzylguanidine
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