title: Clinical potential of oral nicorandil to improve myocardial fatty acid metabolism after percutaneous coronary intervention in hemodialysis patients.
abstract: OBJECTIVE
  The assessment of myocardial fatty acid metabolism impairment by single-photon emission computed tomography (SPECT) using (123)I-β-methyliodophenyl-pentadecanoic acid (BMIPP) might predict the risk of cardiac death in hemodialysis patients. We investigated the potential of oral nicorandil to improve myocardial fatty acid metabolism after percutaneous coronary intervention (PCI) in this population.
  
  
  METHODS
  We evaluated 128 hemodialysis patients who had obtained coronary revascularization by PCI (90 men and 38 women, 66 ± 9 years). Participants for the analysis were randomly assigned to either the nicorandil (n = 63) or control group (n = 65). BMIPP SPECT was performed every year after coronary revascularization by PCI. Uptake on SPECT was graded in 17 segments on a 5-point scale (0, normal; 4, absent) and assessed as BMIPP summed scores (SS).
  
  
  RESULTS
  The incidence of cardiac death was lower (p = 0.004) in the nicorandil group (7/63, 11.1%) than in the control group (21/65, 32.3%) during a mean follow-up of 2.7 ± 1.4 years. BMIPP SS reduction rates improved in the nicorandil group compared with the control group from 3 years of administration. In Kaplan-Meier analyses, free survival rate of cardiac death was higher in patients with a ≥20% BMIPP SS reduction rate as compared with those with a <20% BMIPP SS reduction rate (p = 0.0001). In multiple logistic analysis, oral administration of nicorandil was associated with ≥20% reduction rates of BMIPP SS (odds ratio 2.823, p = 0.011).
  
  
  CONCLUSIONS
  Long-term oral administration of nicorandil may improve impaired myocardial fatty acid metabolism after coronary revascularization by PCI in hemodialysis patients.
authors.affiliation: Cardiovascular Division, Toujinkai Hospital, Kyoto, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nishimura
authors.forename: Yu
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Toshiko
authors.initials: T
authors.lastname: Tokoro
authors.forename: Nodoka
authors.initials: N
authors.lastname: Sato
authors.forename: Masaya
authors.initials: M
authors.lastname: Nishida
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Koji
authors.initials: K
authors.lastname: Okino
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Iwamoto
authors.forename: Hakuo
authors.initials: H
authors.lastname: Takahashi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ono
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005227:Fatty Acids / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000187:drug effects*; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009206:Myocardium / Q000378:metabolism*; D020108:Nicorandil / Q000008:administration & dosage / Q000494:pharmacology*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D014665:Vasodilator Agents; C049338:iodofiltic acid; D020108:Nicorandil