Background Some patients with acute coronary syndrome (ACS) show slow flow after coronary intervention, which seriously affects the prognosis of patients, while nicorandil can improve the coronary microcirculation.
Objective To investigate the effect of intravenous injection of nicorandil before percutaneous coronary intervention (PCI) on coronary perfusion and prognosis in patients with ACS.
Methods Finally 400 patients with ACS who needed PCI treatment were recruited in the study and randomized to nicorandil group and control group, with 200 cases in each group. The nicorandil group received intravenous infusion 3mg/h of nicorandil in 48 hours, the control group received the same amount of 0.9% sodium chloride injection. During PCI, the coronary perfusion was assessed immediately after the stent released. The coronary perfusion was evaluated by TIMI flow grade (TFG) and the corrected TIMI flow frame count (CTFC). The differences in coronary perfusion indicators (TFG and CTFC) and major adverse cardiac events (MACE) during the follow-up were observed between the two groups.
Results In the end, 378 patients completed our trial, including 188 patients in the nicorandil group and 190 patients in the control group. There was no significant difference in basic clinical characteristics or angiographic data between the two groups (P>0.05). The nicorandil group and the control group showed a statistically significant difference in TIMI ≤ Ⅱ after the stent released (5.9% vs 14.2%, P=0.007). Compared with the control group, the nicorandil group had lower CTFC (24.6±6.7 vs 26.3±7.4, P=0.020) and incidence of slow flow (8.5% vs 15.8%, P=0.030). During 36 months of follow-up, the incidence of MACE in the nicorandil group was significantly lower than that in the control group (3.2% vs 10.5%, P=0.005). Multivariate logistic regression analysis showed that nicorandil (OR: 0.304, 95% CI: 0.118-0.783, P=0.014) was an independent predictor of MACE.
Conclusion Intravenous nicorandil can improve coronary perfusion in ACS patients and show obvious improvement in clinical prognosis.
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