Ito H, Taniyama Y, Iwakura K, Nishikawa N, Masuyama T, Kuzuya T, Hori M, Higashino Y, Fujii K, Minamino T
Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
J Am Coll Cardiol. 1999 Mar;33(3):654-60. doi: 10.1016/s0735-1097(98)00604-4.
We assessed whether the intravenous administration of nicorandil, an adenosine triphosphate (ATP)-sensitive K+ channel opener, exerts beneficial effect on microvascular function and functional and clinical outcomes in patients with acute myocardial infarction (AMI).
Experimental studies documented that ATP-sensitive K+ channel opener exerts cardioprotection after prolonged ischemia.
We randomly divided 81 patients with a first anterior AMI into two groups, nicorandil (n = 40) and control groups (n = 41). All patients received successful coronary angioplasty within 12 h after the symptom onset and underwent myocardial contrast echcardiography (MCE) with the intracoronary injection of sonicated microbubbles. In the nicorandil group, we injected 4 mg of nicorandil followed by the infusion at 6 mg/h for 24 h and by oral nicorandil (15 mg/day).
The improvement in regional left ventricular function, wall motion score and regional wall motion was significantly better in the nicorandil group then in the control group. Intractable congestive heart failure, malignant ventricular arrhythmia and pericardial effusion were more frequently found in the control group than in the nicorandil group (15% vs. 37%, 5% vs. 20% and 8% vs. 37%, p < 0.05, respectively). The frequency of sizable MCE no reflow phenomenon was significantly lower in the nicorandil group than in the control group (15% vs. 33%, p < 0.05).
Intravenous nicorandil in conjunction with coronary angioplasty is associated with better functional and clinical outcomes compared to angioplasty alone in patients with an anterior AMI. Myocardial contrast echocardiography findings imply that an improvement in microvascular function with nicorandil may be attributable to this better outcome.
我们评估了静脉注射尼可地尔（一种三磷酸腺苷（ATP）敏感性钾通道开放剂）对急性心肌梗死（AMI）患者微血管功能、功能及临床结局是否具有有益作用。
实验研究表明，ATP敏感性钾通道开放剂在长时间缺血后具有心脏保护作用。
我们将81例首次发生前壁AMI的患者随机分为两组，尼可地尔组（n = 40）和对照组（n = 41）。所有患者在症状发作后12小时内成功接受冠状动脉血管成形术，并通过冠状动脉内注射超声微泡进行心肌对比超声心动图（MCE）检查。在尼可地尔组，我们先注射4 mg尼可地尔，然后以6 mg/h的速度输注24小时，之后口服尼可地尔（15 mg/天）。
尼可地尔组左心室局部功能、壁运动评分及局部壁运动的改善明显优于对照组。对照组中难治性充血性心力衰竭、恶性室性心律失常及心包积液的发生率高于尼可地尔组（分别为15%对37%、5%对20%、8%对37%，p均<0.05）。尼可地尔组MCE无复流现象的发生率显著低于对照组（15%对33%，p < 0.05）。
对于前壁AMI患者，与单纯血管成形术相比，静脉注射尼可地尔联合冠状动脉血管成形术可带来更好的功能及临床结局。心肌对比超声心动图结果提示，尼可地尔改善微血管功能可能是导致这一更好结局的原因。
