Abstract 19111: Intracoronary Nicorandil Improves High Index of Microcirculatory Resistance Values in High Risk Patients on the Global Registry of Acute Coronary Events (GRACE) Risk Score
[Background] In a previous study, a novel index of microcirculatory resistance (IMR) appears to be a better predictor of microvascular dysfunction and recovery of left ventricular function after ST-segment elevation myocardial infarction (STEMI), although no method of treatment of microvascular damage had been established. We therefore demonstrated that intracoronary nicorandil (Nic) can improve coronary microvascular dysfunction in patients (pts) with STEMI treated with primary PCI (AHA2009). However, the impact of IMR values on mortality risk in STEMI remains uncertain.
[Objective] We investigated whether beneficial effects of Nic on microvascular dysfunction are associated with the Global Registry of Acute Coronary Events (GRACE) risk score in pts with STEMI.
[Methods] A total of 71 pts with first STEMI after successful primary PCI underwent baseline IMR measurement immediately after PCI using a PressureWire™ Certus (St. Jude Medical, USA), then received intracoronary Nic 2mg, and finally underwent IMR measurement again. In addition, to investigate differences in effects of Nic, pts were devided into three groups (low-risk: 49–125, intermediate-risk: 126–154 and high-risk: 155–319 on GRACE risk score).
[Results] In the pts with low risk score (n=19) and high risk score (n=33), intracoronary Nic decreased IMR significantly. Although in pts with intermediate risk score (n=19) intracoronary Nic trended to decrease IMR, no significant change in IMR was observed.
[Conclusions] These findings suggested pts with STEMI in high risk on GRACE risk score had significantly higher IMR values than low risk and intracoronary Nic Improves high IMR values in high risk pts. Figure: IMR measurement was performed following primary PCI (Baseline) and immediately after intracoronary Nic (Post Nic). In the pts with low risk score (n=19) and high risk score (n=33), intracoronary Nic decreased IMR significantly.
- © 2010 by American Heart Association, Inc.