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, n = 60) and the placebo group (B, n = 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 99Tcm-methoxyisobutyl isocyanide (MIBI) rest myocardial perfusion imaging (MPI) via single-photon emission computed tomography (99Tcm-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%; p = 0.047) and TMPG 3 (95% vs. 83.33%; p = 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 (p = 0.023); the MPI score of the two groups was 4.1 +/- 1.89 and 7.3 +/- 2.65, respectively (p = 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.