Nicorandil prevents microvascular dysfunction resulting from PCI in patients with stable angina pectoris: a randomised study.
OBJECTIVE
Nicorandil, an ATP sensitive potassium channel opener, may reduce the incidence of microvascular dysfunction after percutaneous coronary intervention (PCI) by dilating coronary resistance vessels. The aim of the study was evaluation of the impact of the administration of intravenous nicorandil on measuring the index of microcirculatory resistance (IMR) in PCI to patients with stable angina pectoris (SAP).


RESULTS
Intravascular ultrasound (IVUS), fractional flow reserve (FFR), IMR and blood examination (CK-MB), cardiac troponin I (cTnI) immediately post-PCI (and 24 hours later) were performed in 62 consecutive patients with SAP undergoing PCI. FFR and IMR were measured simultaneously with a single coronary pressure wire. IMR was defined as Pd/coronary flow (or Pd* mean transit time) at peak hyperaemia. Patients were randomised to the control (n=29), or nicorandil group (n=33). In the nicorandil group, nicorandil was intravenously administered as a 6 mg bolus injection just before PCI and as a constant infusion at 6 mg/hour for 24 hours thereafter. All volumetric IVUS parameters and FFR were similar between the two groups both pre- and post-PCI. However, IMR immediately post-PCI and cTnI 24 hours post-PCI were significantly higher in the control group compared to the nicorandil group (IMR: 25.4±12.1 vs. 17.9±9.1 units, and cTnI: 0.21±0.13 vs. 0.12±0.08 ng/mL, for control vs. nicorandil). The incidence for cTnI elevation more than fivefold the normal range (>0.20 ng/mL) was significantly larger in the control group than in the nicorandil group (41% vs. 12%, p<0.01). Additionally, the control group showed a closer correlation between plaque volume reduction during stenting as assessed by volumetric IVUS, and cTnI elevation than the nicorandil group (r=0.55 vs. 0.42, p<0.001 for control vs. nicorandil).


CONCLUSIONS
In patients undergoing successful coronary stenting for stable angina, administration of nicorandil is associated with reduced microvascular dysfunction induced by PCI.
The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Atsushi
A
Hirohata
Keizo
K
Yamamoto
Eiki
E
Hirose
Yuhei
Y
Kobayashi
Hiroya
H
Takafuji
Fumihiko
F
Sano
Kensuke
K
Matsumoto
Minako
M
Ohara
Ryo
R
Yoshioka
Hiroyuki
H
Takinami
Tohru
T
Ohe
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy; D060050:Angina, Stable / Q000601:surgery*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003326:Coronary Circulation / Q000187:drug effects*; D003331:Coronary Vessels / Q000187:drug effects / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000187:drug effects* / Q000502:physiology; D008875:Middle Aged; D020108:Nicorandil / Q000008:administration & dosage / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D015607:Stents; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects*
D000959:Antihypertensive Agents; D020108:Nicorandil