AIM To investigate whether oral high-dose nicorandil before PCI in acute coronary sysdrome could reduce the incidence of no-reflow/slow-flow and its evaluation of cardioprotective effects.
METHODS This follow-up study to 6 months of a randomized, double-blind trial was conducted among 120 patients with acute coronary syndromes. The investigation was randomized to a control group A and a group B receiving 12 mg nicorandil intravenously and a group C receiving 20 mg orally. Mean follow-up was 1.0 years. Each patient received active comprehensive treatment of coronary heart disease. On the basis of comprehensive treatment, group B and group C were given nicorandil 5 mg three times a day for 6 months, with an average follow-up of half a year.The TIMI flow grade of infarct-related artery, corrected TIMI frame count (cTFC), peak levels of serum cTnT and CK-MB, and occurrence of cardiac events (including recurrent angina pectoris, recurrent myocardial infarction, malignant arrhythmia,heart failure,cardiac death, and non cardiac death.) were observed 1 month, 3 months, and 6 months after PCI among the three groups.
RESULTS The incidence of slow flow and no-reflow in group B and group C was significanty lower than that in group A (P < 0.05), and there was no significant difference in the TIMI flow grade of infarct -related artery and cTFC between group B and group C. The peaks of CK-MB and cTnT in group B and group C were lower than those in the control group (P < 0.05), but there was no significant difference between group B and group C. LVEF increased in group B and group C at 3 months after operation (P < 0.05), and LVEDV decreased significantly (P < 0.05), but there was no significant difference between group B and group C. The value of the half-year admission by heart failure decreased than that of group A (P < 0.05), and there was no significant difference between group B and group C.
CONCLUSION High doses of nicorandil before PCI and continuous use after PCI significantly decreased the incidence of no-reflow/slow flow, and reduced the size of myocardial infarction and improved cardiac function in patients with ACS.
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