title: Impacts of nicorandil on infarct myocardium in comparison with nitrate: assessed by cardiac magnetic resonance imaging.
abstract: In this pilot study, we compared the infarct and edema size in acute myocardial infarction (MI) patients treated by nicorandil with those treated by nitrate, using cardiac magnetic resonance (CMR) imaging. Fifty-two acute MI patients who underwent emergency percutaneous coronary intervention (PCI) were enrolled, and were assigned to receive nicorandil or nitrate at random just before reperfusion. For the assessment of infarct and edema areas, short-axis delayed enhancement (DE) and T2-weight (T2w) CMR images were acquired 6.1 ± 2.4 days after the onset of MI. A significant correlation was observed between the peak creatinine kinase (CK) level and the infarct size on DE CMR (r = 0.62, p < 0.05), as well as the edema size on T2w CMR (r = 0.70, p < 0.05) in patients treated by nicorandil (28 patients). A similar correlation was seen between the peak CK level and the infarct size on DE CMR (r = 0.84, p < 0.05), as well as the edema size on T2w CMR (r = 0.84, p < 0.05) in patients treated by nitrate (24 patients). The maximum CK level was significantly lower in patients treated by nicorandil rather than nitrate (1991 ± 1402, 2785 ± 2121 IU/L, respectively, p = 0.03). Both the edema size on T2w CMR and the infarct size on DE CMR were significantly smaller in patients treated by nicorandil rather than nitrate (17.7 ± 9.9, 21.9 ± 13.7 %; p = 0.03, 10.3 ± 6.0, 12.7 ± 6.9 %, p = 0.03, respectively). The presence and amount of microvascular obstruction were significantly smaller in patients treated by nicorandil rather than nitrate (39.2, 64.7 %; p = 0.03; 2.2 ± 1.3, 3.4 ± 1.5 cm(2); p = 0.02, respectively). Using CMR imaging, we demonstrated that the complementary use of intravenously and intracoronary administered nicorandil during PCI favorably acts more on the damaged myocardium after MI than nitrate. We need a further powered prospective study on the use of nicorandil.
authors.affiliation: Department of Cardiology, Kani Tono Hospital, 1221-5, Dota, Kani, Gifu, 509-0206, Japan. yamakiyo@d6.dion.ne.jp.
authors.forename: Kiyoyasu
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Isobe
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Department of Cardiology, Kani Tono Hospital, 1221-5, Dota, Kani, Gifu, 509-0206, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yokouchi
authors.affiliation: Department of Cardiology, Kani Tono Hospital, 1221-5, Dota, Kani, Gifu, 509-0206, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Iwata
authors.affiliation: Department of Cardiology, Kani Tono Hospital, 1221-5, Dota, Kani, Gifu, 509-0206, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Sawada
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003326:Coronary Circulation / Q000187:drug effects*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D052279:Creatine Kinase, MB Form / Q000097:blood; D004489:Edema, Cardiac / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage*; D007564:Japan; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D020108:Nicorandil / Q000008:administration & dosage*; D005996:Nitroglycerin / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010865:Pilot Projects; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D015415:Biomarkers; D014665:Vasodilator Agents; D020108:Nicorandil; D052279:Creatine Kinase, MB Form; D005996:Nitroglycerin; D007548:Isosorbide Dinitrate
keywords: Acute myocardial infarction; Delayed enhancement; Nicorandil; Nitrate; T2-Weight cardiac magnetic resonance imaging