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Impacts of nicorandil on infarct myocardium in comparison with nitrate: assessed by cardiac magnetic resonance imaging

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Abstract

In this pilot study, we compared the infarct and edema size in acute myocardial infarction (MI) patients treated by nicorandil with those treated by nitrate, using cardiac magnetic resonance (CMR) imaging. Fifty-two acute MI patients who underwent emergency percutaneous coronary intervention (PCI) were enrolled, and were assigned to receive nicorandil or nitrate at random just before reperfusion. For the assessment of infarct and edema areas, short-axis delayed enhancement (DE) and T2-weight (T2w) CMR images were acquired 6.1 ± 2.4 days after the onset of MI. A significant correlation was observed between the peak creatinine kinase (CK) level and the infarct size on DE CMR (r = 0.62, p < 0.05), as well as the edema size on T2w CMR (r = 0.70, p < 0.05) in patients treated by nicorandil (28 patients). A similar correlation was seen between the peak CK level and the infarct size on DE CMR (r = 0.84, p < 0.05), as well as the edema size on T2w CMR (r = 0.84, p < 0.05) in patients treated by nitrate (24 patients). The maximum CK level was significantly lower in patients treated by nicorandil rather than nitrate (1991 ± 1402, 2785 ± 2121 IU/L, respectively, p = 0.03). Both the edema size on T2w CMR and the infarct size on DE CMR were significantly smaller in patients treated by nicorandil rather than nitrate (17.7 ± 9.9, 21.9 ± 13.7 %; p = 0.03, 10.3 ± 6.0, 12.7 ± 6.9 %, p = 0.03, respectively). The presence and amount of microvascular obstruction were significantly smaller in patients treated by nicorandil rather than nitrate (39.2, 64.7 %; p = 0.03; 2.2 ± 1.3, 3.4 ± 1.5 cm2; p = 0.02, respectively). Using CMR imaging, we demonstrated that the complementary use of intravenously and intracoronary administered nicorandil during PCI favorably acts more on the damaged myocardium after MI than nitrate. We need a further powered prospective study on the use of nicorandil.

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Abbreviations

CMR:

Cardiac magnetic resonance

DE:

Delayed enhancement

T2w:

T2 Weight

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

CK:

Creatinine kinase

MB:

Myocardial band isoenzyme

MVO:

Microvascular obstruction

ATP:

Adenosine triphosphate

GMP:

Guanosine monophosphate

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Acknowledgments

I would like to thank the radiology staff in our hospital for their generous support.

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Authors and Affiliations

  1. Department of Cardiology, Kani Tono Hospital, 1221-5, Dota, Kani, Gifu, 509-0206, Japan

    Kiyoyasu Yamada, Kazuhiko Yokouchi, Hirokazu Iwata & Ken Sawada

  2. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Satoshi Isobe, Hideki Ishii & Toyoaki Murohara

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  1. Kiyoyasu Yamada
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  2. Satoshi Isobe
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Correspondence to Kiyoyasu Yamada.

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Yamada, K., Isobe, S., Ishii, H. et al. Impacts of nicorandil on infarct myocardium in comparison with nitrate: assessed by cardiac magnetic resonance imaging. Heart Vessels 31, 1430–1437 (2016). https://doi.org/10.1007/s00380-015-0752-3

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  • DOI: https://doi.org/10.1007/s00380-015-0752-3

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