Abstract 16070: Nicorandil Prevents Troponin T Release in Patients With Acute Heart Failure
OBJECTIVE: Nicorandil (NCR) has protective effects against cardiac damage in patients with coronary artery disease. Circulating cardiac troponin T is a marker for myocardial injury and predicts adverse outcomes in patients with acute coronary syndrome. High-sensitive cardiac troponin T (hs-TnT) is believed to detect myocardial micro-injury, and thus, to be important for risk stratification in patients with heart failure as well as those with coronary artery disease. This study was designed to verify our hypothesis that NCR can protect against myocardial micro-injury, and thus, prevent troponin release in patients with acute heart failure (AHF).
METHODS: This study was a single center, prospective randomized trial. AHF patients were randomly assigned to either the NCR group or the control (CTRL) group. In the NCR group, NCR was administered as a bolus injection of 0.2 mg/kg for 5 min and continuous injection of 0.2 mg/kg/h over 72 h. Additional continuous injection of carperitide 0.0125 mcg/kg/min was started 24 h after initiation of NCR. In the CTRL group, a conventional treatment with continuous injection of carperitide ≥0.0125 μg/kg/min was performed. Other treatments for AHF are permitted in both groups. Levels of hs-TnT and N-terminal pro-brain-natriuretic peptide (NT-proBNP) were measured on admission, at 12 h, 24 h, and 72 h, on day 7, and at discharge.
RESULTS: Total of 56 patients (NCR group, n=25; CTRL group, n=31) were analyzed. In the CTRL group, hs-TnT increased to a peak at 12 h after admission (-0.81±0.57 to -0.49±0.68 log [ng/mL], P=0.01 vs at admission) then decreased up to time of discharge (to -1.47±0.37 log [ng/mL] , P=0.0002 vs at admission). In contrast, in the NCR group, hs-TnT remained unchanged during the observation period (-1.13±0.42 to -1.09±0.46 log [ng/mL] at 12 h, P=0.39 vs at admission). Serial changes in hs-TnT tended to be different in both groups (P=0.08). The level of NT-proBNP was maximum value at admission and showed a similar gradual decrease in both groups.
CONCLUSIONS: Intravenous administration of NCR has been shown to prevent hs-TnT release and protect against myocardial injury in patients with AHF. NCR may be expected to improve long-term outcomes in AHF patients.
- © 2013 by American Heart Association, Inc.