Abstract 4569: Effect on Myocardial Protection of Intracoronary Adenosine and Nicorandil Injection in Patients Undergoing Non-urgernt Percutaneous Coronary Intervention
Background: Several studies showed that adenosine and nicorandil have myocardial protective effects against angioplasty-related myocardial injury. We conducted a prospective, randomized study to investigate the effect on myocardial protection of intracoronary adenosine and nicorandil combination therapy.
Methods: 193 patients were enrolled who were scheduled to undergo non-urgent PCI for de-novo native coronary lesions with stable or unstable angina between November 2007 and June 2008. All patients were pretreated with aspirin and clopidogrel. Patients were randomized to group I (control saline, n=50), group II (adenosine 50ug, n=48), group III (nicorandil 4mg, n=48), and group IV (adenosine-nicorandil combination, n=47). Myocardial necrosis was assessed by elevations of CK-MB, tropinin I (TnI) before PCI and 6h, 12h, 24h after PCI. Primary endpoint is incidence of myocardial necrosis and secondary endpoint is mean CK-MB value and post-procedural MI.
Results: No significant differences were observed among the four groups in terms of the baseline characteristics and laboratory findings. There were no significant diffenence in the incidence of postprocedural myocardial necrosis between each groups (15.7, 15.6, 20.4, 11.1%, respectively, p=0.716). There were no significant diffenence in the incidence of postprocedural MI between each groups (3.9, 4.4, 0, 8.3%, respectively, p=0.268). At 6h after PCI, there were no significant differences in the change of cardiac enzyme among four groups; ΔCK-MB p=0.364), ΔTnI (p=0.627). At 12h after PCI, there were no significant differences in the change of cardiac enzyme among four groups; ΔCK-MB (p=0.779), ΔTnI (p=0.579). No serious adverse event were observed during study except transient AV block and hypotention. Logistic regression analysis was showed that multivessel stenting, stent numbers, median stent lengths and side branch compromised associated with the myonecrosis (p<0.005 in all).
Conclusion: Pretreatment with intracoronary adenosin, nicorandil and combination of two drugs could not reduce the incidence of myocardial necrosis and MI after non-urgent PCI.