Cardioprotective effects of oral nicorandil use in diabetic patients undergoing elective percutaneous coronary intervention.

OBJECTIVE

This study sought to evaluate the cardioprotective role of oral nicorandil (a hybrid between the nitrates and adenosine triphosphate [ATP] sensitive potassium channel activators) in diabetic patients undergoing elective percutaneous coronary intervention (PCI).

BACKGROUND

Myocardial injury commonly occurs during PCI. Several agents that mimic ischemic preconditioning could help minimize this phenomenon.

METHODS

One hundred diabetic patients with stable angina were prospectively enrolled, then randomly assigned to receive oral nicorandil: 20 mg once daily (group A, 50 patients) or placebo (group B, 50 patients) 1 week before and 6 months after PCI. Cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) levels were measured before and 6, 12, and 24 hours post-PCI.

RESULTS

Mean age of the study cohort was 59.8 ± 5.8 years (males = 68%). cTnI level was significantly lower in group A (6 hours: 7.3 ± 0.3 vs. 14.5 ± 0.4 pg/mL; 12 hours: 12.7 ± 0.7 vs. 25.3 ± 0.5 pg/mL; and 24 hours: 7.7 ± 0.5 vs. 15.0 ± 0.4 pg/mL, P < 0.001). After 6 months, the same group showed significantly higher left ventricle ejection fraction (LVEF%), that is, 63.5 ± 7.7% versus 56.5 ± 8.3% (P < 0.05), with a trend toward lower incidence of major adverse cardiac events (MACE).

CONCLUSION

In diabetic patients undergoing elective PCI, nicorandil intake was associated with decreased incidence of PCI-related myocardial injury and improvement of LVEF% after 6 months.