Effect of nicorandil administration on myocardial microcirculation during primary percutaneous coronary intervention in patients with acute myocardial infarction.

INTRODUCTION

Prevention of the no-reflow phenomenon has a crucial role in primary percutaneous coronary intervention (P-PCI) procedures.

AIM

To assess the effects of early intracoronary administration of nicorandil (NIC) during P-PCI on myocardial microcirculation in patients with acute myocardial infarction (AMI).

MATERIAL AND METHODS

A total of 120 patients with first acute anterior wall ST segment elevation myocardial infarction who underwent P-PCI were randomly divided into two groups: the NIC group (A, = 60) and the placebo group (B, = 60). Before stent placement, NIC or normal saline was injected using a guiding catheter. The thrombolysis in myocardial infarction (TIMI) grade, TIMI myocardial perfusion grade (TMPG), resolution of ST segment elevation (defined as > 50% decrease in ST elevation) 1 h after surgery, and Tc-methoxyisobutyl isocyanide (MIBI) rest myocardial perfusion imaging (MPI) single-photon emission computed tomography (Tc-MIBI SPECT) findings 10 days after surgery were compared between the two groups.

RESULTS

The number of patients who achieved TIMI grade 3 (96.67% vs. 86.67%; = 0.047) and TMPG 3 (95% vs. 83.33%; = 0.040) was higher in the NIC group than in the placebo group. Resolution of ST segment elevation occurred in 95% and 81.67% of the patients in the NIC and placebo groups, respectively ( = 0.023); the MPI score of the two groups was 4.1 ±1.89 and 7.3 ±2.65, respectively ( = 0.014).

CONCLUSIONS

Early coronary administration of NIC can significantly reduce the damage in the myocardial microcirculation caused by P-PCI and the myocardial infarct size in patients with AMI.