Nicorandil reduces infarct size in STEMI patients undergoing primary PCI: JAHA

The latest trial found that administering nicorandil before primary percutaneous coronary intervention (pPCI) led to improved myocardial perfusion grade, increased left ventricular ejection fraction, and reduced myocardial infarct size in patients with ST‐segment–elevation myocardial infarction (STEMI). The study was published in the Journal of the American Heart Association. 

Literature shows that Nicorandil improved microvascular dysfunction and reduced reperfusion injury when administered before primary percutaneous coronary intervention. Hence, researchers conducted a multicenter, prospective, randomized, double‐blind clinical trial called the CHANGE trial to investigate the effects of nicorandil administration on infarct size in patients with STEMI treated with primary percutaneous coronary intervention.

238 patients with STEMI participated in the study. Out of these 120 were randomized to receive intravenous nicorandil or placebo (n=118) before reperfusion. Patients in the nicorandil group received a 6‐mg intravenous bolus of nicorandil followed by continuous infusion at a rate of 6 mg/h. Patients in the placebo group received the same dose placebo. Infarct size on cardiac magnetic resonance (CMR) imaging performed at 5 to 7 days and 6 months after reperfusion was the primary endpoint.

Results:

• CMR imaging was performed in 201 patients (84%).
• Infarct size as seen on CMR imaging at 5 to 7 days after reperfusion was significantly smaller in the nicorandil group compared with the placebo (control) group. 
• Long‐term CMR imaging at 6 months after reperfusion was significantly smaller in the Nicorandil group. 
• Nicorandil group showed a lesser incidence of no‐reflow/slow‐flow phenomenon during primary percutaneous coronary intervention.
• Complete ST‐segment resolution was more frequently observed in the nicorandil group.
• Left ventricular ejection fraction on CMR imaging was significantly higher in the nicorandil group than in the placebo group at both 5 to 7 days and 6 months after reperfusion.  

Thus, the researchers concluded that administering nicorandil before primary percutaneous coronary intervention had beneficial effects like improved myocardial perfusion grade, increased left ventricular ejection fraction, and reduced myocardial infarct size in patients with ST‐segment–elevation myocardial infarction. 

To read the full article, click here: https://doi.org/10.1161/JAHA.122.026232 

Qian G, Zhang Y, Dong W, et al. Effects of Nicorandil Administration on Infarct Size in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The CHANGE Trial [published online ahead of print, 2022 Sep 8]. J Am Heart Assoc. 2022;e026232.