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The effect of nicorandil in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Abstract

Aims

To study the effect of nicorandil on prognosis of patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

Methods

We retrieved literatures from Web of Science, Pubmed, Embase, and Cochrane Library. The retrieval time was limited from inception to December 2018.

Results

Nineteen randomized controlled trials involving 2176 patients were finally selected for this study. Meta-analysis showed that nicorandil can significantly reduce corrected TIMI frame count (cTFC) (WMD = − 5.27; 95% CI (− 6.61, − 3.93); P < 0.00001) and improve the no-reflow or slow-reflow phenomenon of coronary arteries (thrombolysis in myocardial infarction (TIMI) ≤ 2) (RR = 0.52; 95% CI (0.40, 0.68); P < 0.001). Compared with control group, nicorandil group has higher left ventricular ejection fraction (LVEF) (WMD = 3.42; 95% CI (1.32, 5.51); P = 0.001), and subgroup analysis showed that sex ratio was one source of heterogeneity (male/female ratio < 4 for low M/F group, M/F > 4 for high M/F group). In the low M/F group, LVEF in nicorandil group was increased significantly (WMD = 4.61; 95% CI (3.03, 6.20); P < 0.001), while there was no significant difference in LVEF between two groups in the high M/F group (WMD = 1.00; 95% CI (− 1.09, 3.09); P = 0.350). In addition, the incidence of in-hospital reperfusion arrhythmia (RR = 0.47; 95% CI (0.36, 0.63); P < 0.00001) and major adverse cardiovascular events (MACEs) (RR = 0.49; 95% CI (0.35, 0.69); P < 0.001) were significantly lower in the nicorandil group than that in control group.

Conclusions

Nicorandil can improve coronary microcirculation and left ventricular function of patients with AMI after PCI. Interestingly, female patients may benefit more from nicorandil than male patients in improving heart function.

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Funding

This work was funded by Science and Technology Project of Nanjing (No. 201803076), Jiangsu Provincial Key Medical Discipline (Laboratory ZDXKA2016023) and Jiangsu Provincial Key Research and Development Program BE2016785.

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Correspondence to Genshan Ma or Yangyang Qu.

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Ji, Z., Zhang, R., Lu, W. et al. The effect of nicorandil in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Ir J Med Sci 189, 119–131 (2020). https://doi.org/10.1007/s11845-019-02034-3

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  • DOI: https://doi.org/10.1007/s11845-019-02034-3

Keywords

  • Acute myocardial infarction
  • Meta-analysis
  • Nicorandil
  • Percutaneous coronary intervention