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Nicorandil affords cardioprotection in patients with acute myocardial infarction treated with primary percutaneous transluminal coronary angioplasty: Assessment with thallium-201/iodine-123 BMIPP dual SPECT

  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

It has been reported that nicorandil restores blood flow to reperfused myocardium in patients with acute myocardial infarction. However, whether nicorandil might decrease infarct size remains unclear. The aim of this study was to assess the effect of nicorandil on infarct size with thallium-201/®-methyl-p-iodophenyl pentadecanoic acid (BMIPP) dual-isotope single photon emission computed tomography.

Methods

A total of 62 patients were randomly assigned to receive intravenous nicorandil (4 mg in 5 minutes at admission, immediately followed by 6mg/hr over a 24-hour period) or placebo. All patients were divided into 4 groups: Group N-a, 16 patients with preexisting angina treated with nicorandil; N-b, 15 patients without preexisting angina treated with nicorandil; Ca, 14 patients with preexisting angina given placebo; C-b, 17 patients without preexisting angina given placebo. Tl-201/BMIPP imaging was performed in the 62 patients within 7 days after admission. Dual-isotope single photon emission computed tomographic images were quantified by severity index with a polar map.

Results

The BMIPP severity index was similar among the 4 groups. Only the thallium severity index in the N-a group was significantly less (P <.05). The ratio of the thallium severity index to that of BMIPP in the N-a group was significantly decreased compared with those of the other groups.

Conclusion

Nicorandil has a protective effect in patients with acute myocardial infarction and preexisting angina treated with primary balloon angioplasty.

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References

  1. Hillis LD, Former S, Braunwald E. Risk stratification before thrombolytic therapy in patients with acute myocardial infarction. J Am Coll Cardiol 1990;16:313–5.

    PubMed  CAS  Google Scholar 

  2. Sheehan FH, Braunwald E, Canner P, Dodge HT, Gore J, Natta PV, et al. The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the thrombolysis in myocardial function (TIMI Phase I) trial. Circulation 1987;75:817–29.

    PubMed  CAS  Google Scholar 

  3. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;2:349–60.

    Google Scholar 

  4. The Global Use of Strategies to Open occluded coronary arteries in acute coronary syndromes (GUSTO IIb) Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med 1997;23:1621–9.

    Article  Google Scholar 

  5. Auchampach JA, Cavero I, Gross GJ. Nicorandil attenuates myocardial dysfunction associated with transient ischemia by opening ATP-dependent potassium channels. J Cardiovasc Pharmacol 1992;20:765–71.

    Article  PubMed  CAS  Google Scholar 

  6. Sakata Y, Kodama K, Komamura K, Lim YJ, Ishikura F, Hirayama A, et al. Salutary effect of adjunctive intracoronary nicorandil administration on restoration of myocardial blood flow and functional improvement in patients with acute myocardial infarction. Am Heart J 1997;133:616–21.

    Article  PubMed  CAS  Google Scholar 

  7. Sakata Y, Kodama K, Ishikura F, Komamura K, Hasegawa S, Sakata Y, et al. Disappearance of the “no-reflow” phenomenon after adjunctive intracoronary administration of nicorandil in a patient with acute myocardial infarction. Jpn Circ J 1997;61:455–8.

    Article  PubMed  CAS  Google Scholar 

  8. Mizunuma T, Nithipatikom K, Gross GJ. Effects of nicorandil and glyceryl trinitrate on infarct size adenosine release, and neutrophil infiltration in the dog. J Cardiovasc Pharmacol 1992;29:482–9.

    Google Scholar 

  9. Klein HH, Pitch S, Lindert-Heimberg S, Shade-Britinger C, Maisch B, Nebendahl K. Comparison study on the effects of intracoronary nicorandil and nitroglycerin in ischaemic, reperfused porcine heart. Eur Heart J 1995;26:477–84.

    Google Scholar 

  10. Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986;74:1124–36.

    PubMed  CAS  Google Scholar 

  11. Hirai T, Fujita M, Yamanishi K, Ohno A, Miwa K, Sasayama S. Significance of preinfarction angina for preservation of left ventricular function in acute myocardial infarction. Am Heart J 1992;124: 19–23.

    Article  PubMed  CAS  Google Scholar 

  12. Pierard LA, Dubois C, Smeets J-P, Boland J, Carlier J, Kulbertus H. Prognostic significance of angina pectoris before first acute myocardial infarction. Am J Cardiol 1988;61:984–7.

    Article  PubMed  CAS  Google Scholar 

  13. Rucco NA, Bergelson BA, Jacobs AK, Frederick MM, Faxon DP, Ryan TJ. Invasive vs. conservative strategy after thrombolytic therapy for acute myocardial infarction in patients with antecedent angina: a report from thrombolysis in myocardial infarction phase II (TIMI II). J Am Coll Cardiol 1992;20:1445–51.

    Google Scholar 

  14. Barbash GI, White HD, Modan M, Van de Werf F. Antecedent angina pectoris predicts worse outcome after myocardial infarction in patients receiving thrombolytic therapy: experience gleaned from the international tissue plasminogen activator/streptokinase mortality trial. J Am Coll Cardiol 1992;20:36–41.

    PubMed  CAS  Google Scholar 

  15. Hashimoto A, Nakata T, Tsuchihashi K, Tanaka S, Fujimori K, Imura O. Post ischemic functional recovery and BMIPP uptake after primary percutaneous transluminal coronary angioplasty in acute myocardial infarction. Am J Cardiol 1996;77:25–30.

    Article  PubMed  CAS  Google Scholar 

  16. Nishimura T, Uehara T, Strauss HW. Radionuclide assessment of stunned myocardium by alternations in perfusion, metabolic and function. Jpn Circ J 1991;55:913–8.

    PubMed  CAS  Google Scholar 

  17. Tamaki N, Kawamoto M, Yonekura Y, Fujibayashi Y, Takahashi N, Konishi J, et al. Regional metabolic abnormality and relation to perfusion and wall motion in patients with myocardial infarction: assessment with emission tomography using branched fatty acid analogue. J Nucl Med 1992;33:659–67.

    PubMed  CAS  Google Scholar 

  18. De Geeter F, Franken PR, Knapp FF Jr, Bossuyt A. Relationship between blood flow and fatty acid metabolism in subacute myocardial infarction: a study by means of Tc-99m sestamibi and I-123 beta-methyl iodophenyl pentadecanoic acid. Eur J Nucl Med 1994;21:283–91.

    Article  PubMed  Google Scholar 

  19. Nishimura T, Uehara T, Shimonagata T, Nagata S, Haze K. Clinical results with beta-methyl-p-(I-123) iodophenyl pentadecanoic acid, single photon emission computed tomography. J Nucl Cardiol 1994;1:522–8.

    Article  Google Scholar 

  20. The TIMI Study Group. The thrombolysis in myocardial infarction (TIMI) trial: phase 1 findings. N Engl J Med 1985;312:932–6.

    Google Scholar 

  21. Tsuji A, Kojima A, Matsumoto M, Oyama Y, Tominaga S, Tomohiro K, et al. A new method for cross talk correction in simultaneous dual-isotope myocardial imaging with Tl-201 and I-123. Ann Nucl Med 1999;13:317–23.

    PubMed  CAS  Google Scholar 

  22. Fujibayashi Y, Yonekura Y, Takemura Y, Wada K, Matsumoto K, Tamaki N, et al. Myocardial accumulation of iodinated beta-methylbranched fatty acid and analogue, iodine-125-15-(p-iodophenyl)-3- (R,S) methylpentadecanoic acid (BMIPP), in reaction to ATP concentration. J Nucl Med 1990;31:1818–22.

    PubMed  CAS  Google Scholar 

  23. Cohen MV, Downey JM. Myocardial stunning in dogs: preconditioning effect and influence of coronary collateral flow. Am Heart J 1990;120:282–91.

    Article  PubMed  CAS  Google Scholar 

  24. Cohen MV, Liu GS, Downey JM. Preconditioning causes improved wall motion as well as smaller infarction after transient coronary occlusion in rabbits. Circulation 1991;84:341–9.

    PubMed  CAS  Google Scholar 

  25. Ovize M, Przyklenk K, Hale SL, Kloner RA. Preconditioning does not attenuate myocardial stunning. Circulation 1992;85:779–89.

    PubMed  CAS  Google Scholar 

  26. Murry CE, Richard VJ, Reimer KA, Jennings RB. Ischemic preconditioning slows energy metabolism and delays ultrastructural damage during a sustained ischemic episode. Circ Res 1990;66:913–31.

    PubMed  CAS  Google Scholar 

  27. Schwaiger M, Schelbert HR, Ellison D, Hansen H,Yeatman L, Vinten-Johansen J, et al. Sustained regional abnormalities in cardiac metabolism after transient ischemia in the chronic dog model. J Am Coll Cardiol 1985;6:336–47.

    Article  PubMed  CAS  Google Scholar 

  28. Taira N. Similarity and dissimilarity in the mode and mechanism of action between nicorandil and classical nitrates: an overview. J Cardiovasc Pharmacol 1987;10:S1–9.

    Article  PubMed  CAS  Google Scholar 

  29. Gross GJ, Auchampach JA, Maruyama M, Warltier DC, Pieper GM. Cardioprotective effects of nicorandil. J Cardiovasc Pharmacol 1992;20:S22–28.

    Article  PubMed  CAS  Google Scholar 

  30. Yao Z, Gross G. Glibenclamide antagonizes adenosine A1 receptormediated cardioprotection in stunned canine myocardium. Circulation 1993;88:235–44.

    PubMed  CAS  Google Scholar 

  31. Mizunuma T, Saito S, Ozawa Y, Kamimatsuse K, Gross GJ. An ATPsensitive potassium channel opener, nicorandil, lowers the threshold for ischemic preconditioning in barbital-anesthetized dogs. Heart Vessels 1997;Suppl12:175–7.

    Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Funabashi Municipal Medical Center, 1-21-1, Kanasugi, Funabashi, 273-8588, Chiba, Japan

    Shigeru Fukuzawa, Shun Ozawa, Masayuki Inagaki, Kazuhiro Shimada, Juji Sugioka, Kaoru Tateno & Marehiko Ueda

Authors
  1. Shigeru Fukuzawa
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  2. Shun Ozawa
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  3. Masayuki Inagaki
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  4. Kazuhiro Shimada
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  5. Juji Sugioka
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  6. Kaoru Tateno
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  7. Marehiko Ueda
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Correspondence to Shigeru Fukuzawa.

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Fukuzawa, S., Ozawa, S., Inagaki, M. et al. Nicorandil affords cardioprotection in patients with acute myocardial infarction treated with primary percutaneous transluminal coronary angioplasty: Assessment with thallium-201/iodine-123 BMIPP dual SPECT. J Nucl Cardiol 7, 447–453 (2000). https://doi.org/10.1067/mnc.2000.107273

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  • DOI: https://doi.org/10.1067/mnc.2000.107273

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