Myocardial protective effects of nicorandil during percutaneous coronary intervention in patients with unstable angina

Background The purpose of the study was to prospectively evaluate the protective effect of nicorandil during percutaneous coronary intervention (PCI) in patients with unstable angina (UAP). Methods and Results Two hundred patients (61 +/- 10 year-old, male 143) diagnosed with UAP at an emergency medical center were randomly assigned to 2 groups: intravenous isosorbide dinitrate, Group I (n = 100), or intravenous nicorandil, Group H (n = 100). PCI was performed 12-48h after infusion of each agent. Serum concentrations of creatine kinase-MB (CK-MB), cardiac troponin T (cTnT), and I (cTnI) were measured before and 6, 12, 24h after PCI. Patients with non-coronary chest pain, requiring emergency coronary angiogram, temporary pacemaker or glycoprotein IIb/IIIa receptor blocker were excluded. PCI was successfully performed in 96 patients (Group I = 54, 61.7 +/- 8.2 years, 32 males; Group II = 42, 60.4 +/- 11.7 years, 27 males). No significant differences in clinical or coronary angiographic characteristics were observed between the 2 groups. The concentration of CK-MB was elevated in 9 patients (17%) of Group I and 6 (14%) of Group 11, cTnT in 16 (30%), 6 (14%) and cTnI in 25 (46%), 9 (21%) after PCI. Elevation of any troponin was less frequent in Group II [28/54 (52%) vs 10/42 (24%) patients, p = 0.01]. Major adverse coronary events during the 6-month clinical follow-up occurred in 9 (17%) of Group I and 5 patients of Group II (12%, p = NS). Follow-up echocardiography revealed lower left ventricular ejection fraction in Group I than in Group H (65.4 +/- 7.2% vs 71.0 +/- 6.7%, p = 0.03). Conclusion Nicorandil has a myocardial protective effect during PCI in patients with UAP.