Intravenous nicorandil can preserve microvascular integrity and myocardialviability in patients with reperfused anterior wall myocardial infarction

OBJECTIVES We assessed whether the intravenous administration of nicorandil , an adenosine triphosphate (ATP)-sensitive K+ channel opener, exerts benef icial effect-on microvascular function and functional and clinical outcomes in patients with acute myocardial infarction (AMI). BACKGROUND Experimental studies documented that ATP-sensitive K+ channel op ener exerts cardioprotection after prolonged ischemia. METHODS We randomly divided 81 patients with a first anterior AMI into two groups, nicorandil (n = 40) and control groups (n = 41). All patients recei ved successful coronary angioplasty within 12 h after the symptom onset and underwent myocardial contrast echcardiography (MCE) with the intracoronary injection of sonicated microbubbles. In the nicorandil group, we injected 4 mg of nicorandil followed by the infusion at 6 mg/h for 24 h and by oral nicorandil (15 mg/day). RESULTS The improvement in regional left ventricular function, nail motion score and regional wall motion was significantly better in the nicorandil g roup then in the control group. Intractable congestive heart failure, malig nant ventricular arrhythmia and pericardial effusion were more frequently f ound in the control group than in the nicorandil group (15% vs. 37%, 5% vs. 20% and 8% vs. 37%, p < 0.05, respectively). The frequency of sizable MCE no reflow phenomenon was significantly lower in the nicorandil group than i n the control group (15% vs. 33%, p < 0.05). CONCLUSIONS Intravenous nicorandil in conjunction with coronary angioplasty is associated with better functional and clinical outcomes compared to ang ioplasty alone in patients with an anterior AMI. Myocardial contrast echoca rdiography findings imply that an improvement in microvascular function wit h nicorandil may be attributable to this better outcome. CT Am (C) 1999 by the American College of Cardiology.