Key result
Targeted intracoronary nicorandil improves myocardial perfusion by ~19 frames vs nitroglycerin during elective PCI.
Why the study?
The study was conducted to evaluate the efficacy of nicorandil and alprostadil on myocardial protection in patients undergoing elective PCI.
Does intracoronary administration of nicorandil or alprostadil improve myocardial perfusion in patients undergoing elective PCI compared to nitroglycerin?
RCT (n=90)
Single-blind
Computer-generated numbers
No
Does intracoronary administration of nicorandil or alprostadil improve myocardial perfusion in patients undergoing elective PCI compared to nitroglycerin?
Effect estimate: Mean difference 18.8 (95% CI 7.1-30.3)
Absolute Event Rate: 21.2% vs 2.3%
p-value: p=0.002
Intracoronary administration of nicorandil or alprostadil via a targeted perfusion microcatheter is more effective than nitroglycerin in improving myocardial perfusion during elective PCI.
Supports targeted nicorandil over nitroglycerin for perfusion in elective PCI; extends RCT evidence for microcatheter delivery.
BACKGROUND: The aim of the study was to evaluate the efficacy of nicorandil and alprostadil on myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI). METHODS: In this prospective, single-blinded, randomized controlled study, 90 consecutive patients scheduled for elective PCI for de novo coronary lesions were assigned to the nicorandil, alprostadil, and nitroglycerin groups in a 1:1:1 ratio. Drugs were administered intracoronary via a targeted perfusion microcatheter. The primary endpoint was the thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC). Additionally, the corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), and incidence of periprocedural myocardial injury (PMI) were assessed. RESULTS: Both nicorandil and alprostadil were significantly effective in reducing TMPFC (114.6 ± 33.7 vs 93.4 ± 30.9, P = .016; 114.3 ± 34.3 vs 94.7 ± 33.3, P = .029, respectively). Similar findings were observed in the improvement of cTFC (20.3 ± 10.5 vs 13.5 ± 5.0, P = .003; 20.2 ± 7.4 vs 15.2 ± 5.2, P = .003, respectively) and percentage of TMPG 3 (100% vs 82.8%, P = .052; 83.3% vs 96.7%, P = .196, respectively); whereas, nitroglycerin produced a limited effect on TMPFC (114.4 ± 30.9 vs 112.1 ± 31.9, P = .739), cTFC (19.4 ± 7.2 vs 19.3 ± 7.2, P = .936), and percentage of TMPG 3 (86.7% vs 86.7%, P = 1.000). No significant difference was found in the incidence of PMI (16.7% vs 16.0% vs 27.6%, P = .537), though it was comparatively lower in the nicorandil and alprostadil groups. Furthermore, the intracoronary administration of nicorandil and alprostadil had a mild effect on blood pressure and heart rate. CONCLUSIONS: The intracoronary administration of nicorandil and alprostadil via a targeted perfusion microcatheter was more effective in improving myocardial perfusion in patients undergoing elective PCI than nitroglycerin.
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Zhang et al. (2021) conducted an RCT in Non-acute coronary syndrome undergoing elective percutaneous coronary intervention (n=90). Nicorandil or Alprostadil vs. Nitroglycerin was evaluated on Change in TIMI myocardial perfusion frame count (TMPFC) (Mean difference 18.8, 95% CI 7.1-30.3, p=0.002). Intracoronary administration of nicorandil via a targeted perfusion microcatheter significantly improved myocardial perfusion compared to nitroglycerin (mean difference in TMPFC change 18.8 frames) in patients undergoing elective PCI.
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