Yang Jing, Zhang Jidong, Cui Wei, Liu Fan, Xie Ruiqin, Yang Xiaohong, Gu Guoqiang, Zheng Hongmei, Lu Jingchao, Yang Xiuchun, Zhang Guangming, Wang Qian, Geng Xue
Department of Cardiology, the Second Hospital of Hebei Medical University; Shijiazhuang City P.R.-China.
Anatol J Cardiol. 2015 Feb;15(2):125-31. doi: 10.5152/akd.2014.5207. Epub 2014 Apr 16.
Nicorandil, an opener of ATP-sensitive K+ channels, was used to treat angina in patients with coronary artery disease. In this study, we aim to investigate the cardioprotective effects of single oral dose of nicorandil in patients undergoing selective percutaneous coronary intervention (PCI).
One hundred and thirty-eight patients with acute coronary syndrome undergoing PCI from July 2011 to October 2012 were randomly divided into control group (group 1, n = 47), 10 mg oral nicorandil group (group 2, n = 45), and 20 mg oral nicorandil group (group 3, n = 46) about 2 hours before procedure, respectively. Cardiac troponin I (cTnI) levels were determined at 20 ~ 24 hours after PCI.
There was a significant difference in the rate of any cTnI elevation among the three groups (group 1: 36.17%, group 2: 20.00%, group 3: 15.22%, p = 0.0176). With respect to the frequency of cTnI elevation ≥ 3 and 5 × the upper limit of normal (ULN), there also had statistical difference among the three groups (17.02% in group 1, 8.89% in group 2, and 4.35% in group 3, respectively for cTnI elevation ≥ 3 × ULN, p = 0.0428; 12.77% in group 1, 6.67% in group 2, and 2.17% in group 3, respectively, for cTnI elevation ≥ 5 × ULN, p = 0.0487). Logistic regression analysis showed that LVEF (OR = 0.915, 95% CI = 0.853-0.981) and the use of nicorandil (OR = 0.516, 95% CI = 0.267-0.996) before PCI were independent protective factors of myocardial injury.
Single oral dose of nicorandil (10 mg, 20 mg) 2 hours before the PCI procedure could decrease the incidence of peri-procedure myocardial injury and PCI-related myocardial infarction.
尼可地尔是一种ATP敏感性钾通道开放剂，用于治疗冠状动脉疾病患者的心绞痛。在本研究中，我们旨在探讨单次口服尼可地尔对接受选择性经皮冠状动脉介入治疗（PCI）患者的心脏保护作用。
选取2011年7月至2012年10月期间138例接受PCI的急性冠状动脉综合征患者，在手术前约2小时分别随机分为对照组（第1组，n = 47）、口服10 mg尼可地尔组（第2组，n = 45）和口服20 mg尼可地尔组（第3组，n = 46）。在PCI术后20~24小时测定心肌肌钙蛋白I（cTnI）水平。
三组间任何cTnI升高率有显著差异（第1组：36.17%，第2组：20.00%，第3组：15.22%，p = 0.0176）。关于cTnI升高≥3倍和5倍正常上限（ULN）的频率，三组间也有统计学差异（cTnI升高≥3倍ULN时，第1组为17.02%，第2组为8.89%，第3组为4.35%，p = 0.0428；cTnI升高≥5倍ULN时，第1组分别为12.77%，第2组为6.67%，第3组为2.17%，p = 0.0487）。Logistic回归分析显示，PCI术前左心室射血分数（LVEF，OR = 0.915，95%CI = 0.853 - 0.981）和使用尼可地尔（OR = 0.516，95%CI = 0.267 - 0.996）是心肌损伤的独立保护因素。
PCI术前2小时单次口服尼可地尔（10 mg、20 mg）可降低围手术期心肌损伤及PCI相关心肌梗死的发生率。
