Key result
Prophylactic use of oral nicorandil before primary percutaneous coronary intervention significantly increased the rate of complete myocardial perfusion (TIMI Grade-3 flow) to 87.1% compared to 20.0% with conventional protocol alone (p=0.001).
Why the study?
The study was conducted to evaluate the effect of nicorandil in preventing reperfusion injury during primary PCI using TIMI flow grade scoring.
Does prophylactic oral nicorandil improve TIMI flow grade scoring and prevent reperfusion injury in STEMI patients undergoing primary PCI?
Observational (n=140)
No
Does prophylactic oral nicorandil improve TIMI flow grade scoring and prevent reperfusion injury in STEMI patients undergoing primary PCI?
Absolute Event Rate: 87.1% vs 20%
p-value: p=0.001
A single 20 mg oral dose of nicorandil given prior to primary PCI in STEMI patients significantly improves angiographic reperfusion (TIMI flow grade) compared to standard therapy alone.
May support adjunctive nicorandil before primary PCI in STEMI; hypothesis-generating and should not yet change practice.
Objectives: To evaluate the effect of nicorandil in prevention of reperfusion injury during primary percutaneous coronary intervention by thrombolysis in myocardial infarction flow grade scoring. Methods: A total of 140 patients from Rawalpindi Institute of Cardiology were enrolled in this study conducted from 7th September to 10th of October 2021. These participants were allocated into two major groups. Control group received conventional acute coronary syndrome protocol regimen only whereas experimental group was given nicorandil along with conventional acute coronary syndrome protocol. During primary percutaneous coronary intervention, thrombolysis in myocardial infarction flow grade scoring was analyzed and compared. Results: Majority of participants in nicorandil group achieved thrombolysis in myocardial infarction Grade-3 scoring which indicated reduced rate of no reflow phenomenon as compared to control group. A statistically significant difference was noted in score of both groups (p value = 0.001) signifying prophylactic use of nicorandil before primary percutaneous coronary intervention along with conventional acute coronary syndrome protocol is superior to only conventional acute coronary syndrome protocol regimen to cases in the control group. Conclusion: Use of nicorandil in ST elevated myocardial infarction patients before primary percutaneous coronary intervention prevents reperfusion injury thus decreasing the risk of post percutaneous coronary intervention complications and reducing mortality rate in cardiac patients suggesting its significant cardio protective role. doi: https://doi.org/10.12669/pjms.39.1.6034 How to cite this: Ilyas M, Noor M, Khan HS, Haroon S, Farhat K, Ali S. Cardio protective effect of nicorandil in reperfusion injury among patients undergoing primary percutaneous coronary intervention. Pak J Med Sci. 2023;39(1):177-181. doi: https://doi.org/10.12669/pjms.39.1.6034 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Ilyas et al. (2022) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=140). Nicorandil vs. Conventional acute coronary syndrome protocol was evaluated on Complete myocardial perfusion (TIMI Grade-3 flow) (p=0.001). Prophylactic use of oral nicorandil before primary percutaneous coronary intervention significantly increased the rate of complete myocardial perfusion (TIMI Grade-3 flow) to 87.1% compared to 20.0% with conventional protocol alone (p=0.001).
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