Key result
Nicorandil-based therapy was associated with greater 12-month SAQ summary score improvement than non-nicorandil therapy in angina patients with CMVD (16.80 vs 12.60; MD 4.20, P=0.044).
Why the study?
Coronary microvascular dysfunction represents an important unmet clinical need in patients with angina and non-obstructive coronary arteries, and studies evaluating the comparative efficacy of nicorandil versus non-nicorandil treatments across CMVD and non-CMVD populations remain limited.
Does a nicorandil-based regimen improve Seattle Angina Questionnaire summary scores at 12 months compared to non-nicorandil treatment in angina pectoris patients with coronary microvascular dysfunction?
Observational (n=1,259)
Yes
Does a nicorandil-based regimen improve Seattle Angina Questionnaire summary scores at 12 months compared to non-nicorandil treatment in angina pectoris patients with coronary microvascular dysfunction?
In this multicenter observational cohort study, nicorandil-based therapy was associated with significantly greater improvements in angina-related health status (SAQ summary score) over 12 months compared with non-nicorandil regimens in patients both with and without coronary microvascular dysfunction.
Answers are grounded in this paper and cite their sources.
May support nicorandil in CMVD angina; hypothesis-generating and requires RCTs before practice change.
Background Coronary microvascular dysfunction (CMD or CMVD), a major subtype of angina with non-obstructive coronary arteries, affects a substantial proportion of patients and represents an important unmet clinical need, particularly in China. Studies evaluating comparative treatment efficacy in angina populations, especially across CMVD and non-CMVD, remain limited. Objective To assess the efficacy of different therapeutic regimens (nicorandil vs. non-nicorandil treatment) among angina pectoris patients with CMVD. Methods We conducted a retrospective analysis of baseline and follow-up data from nine centres of the GREAT study, including patients with angina from nine hospitals in China treated with nicorandil or non-nicorandil regimens. Patients with and without CMVD (coronary angiography-derived index of microvascular resistance [caIMR], ≥25 vs. < 25) were included, and post-treatment differences in Seattle Angina Questionnaire (SAQ) scores were compared between groups. Results A total of 1,259 patients with angina were included in this study. Among them, 429 patients had CMVD (caIMR ≥25), comprising 170 in the nicorandil group and 259 in the non-nicorandil group, while 830 patients did not have CMVD (nicorandil group, 319; non-nicorandil group, 511). After propensity score matching, the mean SAQ summary score (SAQ-SS) improvement in patients with CMVD, was greater in the nicorandil group than in the non-nicorandil group (mean change: 16.80 vs. 12.60, P = 0.044). Among patients without CMVD, nicorandil therapy resulted in significantly greater SAQ-SS improvement at respective timepoints (3 months: 15.68 vs. 12.15, P = 0.005; 6 months: 18.70 vs. 14.44, P < 0.001; 9 months: 18.11 vs. 15.07, P = 0.008). Conclusion Nicorandil-based regimens may be associated with greater improvement in health status among angina patients with CMVD compared with non-nicorandil treatments.
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Zhang et al. (2026) conducted an observational in Angina pectoris with and without coronary microvascular dysfunction (CMVD) (n=1,259). Nicorandil-based regimen vs. Non-nicorandil antianginal regimen was evaluated on Change from baseline in Seattle Angina Questionnaire summary score (SAQ-SS) at 12 months in the CMVD cohort (post-propensity score matching) (MD 4.20, 95% CI 0.12-8.29, p=0.044). Nicorandil-based therapy was associated with greater 12-month SAQ summary score improvement than non-nicorandil therapy in angina patients with CMVD (16.80 vs 12.60; MD 4.20, P=0.044).
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