Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
J Int Med Res. 2020 Nov;48(11):300060520967856. doi: 10.1177/0300060520967856.
There is controversy whether nicorandil treatment has cardioprotective effects in patients with acute myocardial infarction (AMI) following percutaneous coronary intervention (PCI). This meta-analysis was conducted to assess the efficacy of nicorandil on functional and clinical outcomes after PCI.
Systematic databases were searched to retrieve studies that compared the effect of nicorandil with a control group in patients with AMI who underwent PCI. Outcomes related to coronary blood flow, and functional and clinical outcomes were extracted and a meta-analysis was performed. Trial sequential analysis was conducted to estimate the required sample size for statistical power.
Twenty-four trials involving 2965 patients with AMI were enrolled. Pooled results showed that nicorandil treatment significantly suppressed the incidence of no-reflow phenomenon and reperfusion arrhythmia after reperfusion, improved the left ventricular ejection fraction and left ventricular end-systolic volume index, and reduced major adverse cardiovascular events and cardiovascular death. Trial sequential analysis confirmed the effect of nicorandil in reducing the incidence of no-reflow phenomenon and follow-up major adverse cardiovascular events in patients with AMI after PCI.
Our findings suggest that nicorandil treatment adjunctive to reperfusion therapy improves myocardial reperfusion, cardiac function, and clinical outcomes in patients with AMI.
关于硝酸异山梨酯治疗经皮冠状动脉介入治疗（PCI）后急性心肌梗死（AMI）患者是否具有心脏保护作用，尚存争议。本荟萃分析旨在评估硝酸异山梨酯对 PCI 后患者功能和临床结局的疗效。
系统检索数据库，以检索比较硝酸异山梨酯与对照组在接受 PCI 的 AMI 患者中的疗效的研究。提取与冠状动脉血流以及功能和临床结局相关的结局，并进行荟萃分析。进行试验序贯分析以估计达到统计功效所需的样本量。
共纳入 24 项涉及 2965 例 AMI 患者的试验。汇总结果表明，硝酸异山梨酯治疗可显著降低再灌注后无复流现象和再灌注心律失常的发生率，改善左心室射血分数和左心室收缩末期容积指数，并降低主要不良心血管事件和心血管死亡的发生率。试验序贯分析证实了硝酸异山梨酯在降低 PCI 后 AMI 患者无复流现象和随访期间主要不良心血管事件发生率方面的作用。
我们的研究结果表明，硝酸异山梨酯辅助再灌注治疗可改善 AMI 患者的心肌再灌注、心功能和临床结局。
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