Abstract 9292: Impact of Nicorandil on Infarct Myocardium in Comparison With Nitrate: Assessed by Cardiac Magnetic Resonance Imaging

Abstract

ObjectivesThe complementary intravenous administration of nicorandil, a hybrid compound of ATP-sensitive potassium channel opener and nitric donor, to percutaneous coronary intervention (PCI) reportedly has a protective effect on the infarct myocardium, leading to improve clinical outcome in patients with acute myocardial infarction (AMI). We compared the infarct and edema size in AMI patients intravenously treated by nicorandil with those by nitrate, using cardiac magnetic resonance (CMR) imaging.

Methods The double-blinded trial was conducted in 52 AMI patients who successfully underwent emergency PCI. The patients were assigned to receive nicorandil or nitrate just before reperfusion at random. For the assessment of infarct and edema areas, short-axis T2w and delayed enhancement (DE) CMR images were acquired 6.1 ± 2.4 days after the onset of AMI.

Results The edema size on T2w CMR was significantly larger than the infarct size on DE CMR (p < 0.05). A significant correlation was observed between the peak creatine kinase (CK) levels and infarct size on DE CMR (r = 0.62, p < 0.05) as well as the edema size on T2w CMR (r = 0.7, p < 0.05) in patients treated by nicorandil. A similar correlation was seen between the peak CK levels and 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. The maximum serum CK level was significantly lower in patients treated by nicorandil than those by nitrate (2132 ± 1689 IU. vs 2785 ± 2121 IU. ; p < 0.05). Both the edema size on T2w CMR and the infarct size on DE CMR were significantly smaller in patients treated by nicorandil than those by nitrate (edema size; 17.7 ± 9.9 % vs 21.9 ± 13.7 % ; infarct size; 10.3 ± 6.0 % vs 12.7 ± 6.9 % ; p < 0.05, respectively).

Conclusion Using CMR imaging, we demonstrate that the complementary intravenous administration of nicorandil to PCI provides more favorable effects in reducing myocardial damage compared with nitrate.