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Zhang Y, Zou J, Wan F, Peng F, Peng C. Update on the sources, pharmacokinetics, pharmacological action, and clinical application of anisodamine. Biomed Pharmacother 2023; 161:114522. [PMID: 37002581 DOI: 10.1016/j.biopha.2023.114522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Anisodamine is an anticholinergic drug extracted and isolated from the Anisodus tanguticus (Maxim.) Pascher of the Solanaceae family which is also a muscarinic receptor antagonist. Owing to the lack of natural sources of anisodamine, synthetic products are now used. Using ornithine and arginine as precursor compounds, putrescine is catalyzed by different enzymes and then undergoes a series of reactions to produce anisodamine. It has been used clinically to protect cardiac function and treat septic shock, acute pancreatitis, calculous renal colic, bronchial asthma, blood circulation disturbances, jaundice, analgesia, vertigo, acute poisoning, and other conditions.This review describes the relevant pharmacokinetic parameters. Anisodamine is poorly absorbed in the gastrointestinal tract, and it is not as effective as intravenous administration. For clinical medication, intravenous infusion should be used rather than rapid intravenous injection. With the advancement of research in recent years, the application scope of anisodamine has expanded, with significant developments and application values surging.This review systematically describes the sources, pharmacokinetics, pharmacological effects and clinical application of anisodamine, in order to provide a basis for clinical use.
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Ilyas M, Noor M, Khan HS, Haroon S, Farhat K, Ali S. Cardio protective effect of nicorandil in reperfusion injury among patients undergoing primary percutaneous coronary intervention. Pak J Med Sci 2023; 39:177-181. [PMID: 36694786 PMCID: PMC9842976 DOI: 10.12669/pjms.39.1.6034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/05/2022] [Accepted: 10/26/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives To evaluate the effect of nicorandil in prevention of reperfusion injury during primary percutaneous coronary intervention by thrombolysis in myocardial infarction flow grade scoring. Methods A total of 140 patients from Rawalpindi Institute of Cardiology were enrolled in this study conducted from 7th September to 10th of October 2021. These participants were allocated into two major groups. Control group received conventional acute coronary syndrome protocol regimen only whereas experimental group was given nicorandil along with conventional acute coronary syndrome protocol. During primary percutaneous coronary intervention, thrombolysis in myocardial infarction flow grade scoring was analyzed and compared. Results Majority of participants in nicorandil group achieved thrombolysis in myocardial infarction Grade-3 scoring which indicated reduced rate of no reflow phenomenon as compared to control group. A statistically significant difference was noted in score of both groups (p value = 0.001) signifying prophylactic use of nicorandil before primary percutaneous coronary intervention along with conventional acute coronary syndrome protocol is superior to only conventional acute coronary syndrome protocol regimen to cases in the control group. Conclusion Use of nicorandil in ST elevated myocardial infarction patients before primary percutaneous coronary intervention prevents reperfusion injury thus decreasing the risk of post percutaneous coronary intervention complications and reducing mortality rate in cardiac patients suggesting its significant cardio protective role.
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Affiliation(s)
- Maria Ilyas
- Dr. Maria Ilyas, MBBS., Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Mudassar Noor
- Dr. Mudassar Noor, Associate Professor of Pharmacology, Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Hamid Sharif Khan
- Dr. Hamid Sharif Khan, Assistant Professor of Cardiology, Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Sauleha Haroon
- Dr. Sauleha Haroon, Senior Registrar of Cardiology, Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Kulsoom Farhat
- Dr. Kulsoom Farhat, Professor of Pharmacology, Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Shabana Ali
- Dr. Shabana Ali, Assistant Professor of Pharmacology, Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan
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Wang ZD, Chen YX, Liu M, Li P, Liang XW, Zhu XZ, Xie WC, Liao W. Safety of Bivalirudin Combined with Ticagrelor in the Emergency PCI in Patients with Acute ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost 2022; 28:10760296221077973. [PMID: 36520539 PMCID: PMC9768824 DOI: 10.1177/10760296221077973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The present study aimed to investigate the application safety of bivalirudin combined with ticagrelor in the emergency percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS From October 1, 2018, to December 30, 2019, 210 patients with STEMI admitted to the Department of Cardiology who underwent emergency PCI were randomly divided into the bivalirudin group (group A, N = 105) and the unfractionated heparin group (group B, N = 105). Before the emergency PCI operation after admission, the loading dose of aspirin (300 mg) was given orally, and then 100 mg/d. At the same time, the loading dose of ticagrelor (180 mg) was administered orally, and then 90 mg/bid. The adverse events and the hemorrhage events 30 days after the operation were observed and recorded. RESULTS There were five hemorrhage cases in the bivalirudin group, with one case of secondary hemorrhage and four cases of mild hemorrhage. There were 14 hemorrhages in the unfractionated heparin group with one case of secondary hemorrhage and thirteen cases of mild hemorrhage. In terms of mild hemorrhage, the hemorrhage rate in the bivalirudin group was significantly lower than that in the unfractionated heparin group (3.8% vs. 12.4%, P = 0.040). One patient died in the unfractionated heparin group, while no deaths occurred in the bivalirudin group during the thirty days of follow-up. No myocardial infarction, revascularization, or stroke occurred in the two groups within 30 days after the operation. CONCLUSION Compared with unfractionated heparin combined with ticagrelor in patients with STEMI undergoing emergency PCI treatment, bivalirudin combined with ticagrelor could significantly reduce the occurrence of mild hemorrhage events, and it would not increase the incidence of MACE during the 30 days of follow-up.
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Affiliation(s)
- Zheng-Dong Wang
- Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), No. 495 Education Middle Road, Yuzhou District, Yulin 537000, Guangxi, China
| | - Yu-Xiang Chen
- Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), No. 495 Education Middle Road, Yuzhou District, Yulin 537000, Guangxi, China
| | - Ming Liu
- Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), No. 495 Education Middle Road, Yuzhou District, Yulin 537000, Guangxi, China
| | - Ping Li
- Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), No. 495 Education Middle Road, Yuzhou District, Yulin 537000, Guangxi, China,Ping Li, Department of Cardiology,Yulin First People's Hospital(The Sixth Affiliated Hospital of Guangxi Medical University), No.495 Education Middle Road, Yuzhou District, Yulin 537000, Guangxi, China.
| | - Xiang-Wen Liang
- Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), No. 495 Education Middle Road, Yuzhou District, Yulin 537000, Guangxi, China
| | - Xian-Zhang Zhu
- Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), No. 495 Education Middle Road, Yuzhou District, Yulin 537000, Guangxi, China
| | - Wen-Chao Xie
- Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), No. 495 Education Middle Road, Yuzhou District, Yulin 537000, Guangxi, China
| | - Wang Liao
- Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), No. 495 Education Middle Road, Yuzhou District, Yulin 537000, Guangxi, China
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Gupta H, Parihar S, Tripathi V. Assessment of the Efficacy and Safety of Early Intracoronary Nicorandil Administration in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Cureus 2022; 14:e25349. [PMID: 35761910 PMCID: PMC9233414 DOI: 10.7759/cureus.25349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/05/2022] Open
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Sinha SK, Kumar P, Sharma AK, Razi M, Pandey U, Sachan M, Shukla P, Aggarwal P, Jha MJ, Thakur R, Krishna V. Perforated balloon technique mediated intracoronary delivery of nicorandil to treat coronary no-reflow phenomenon: a novel pharmacological solution to precarious situation. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:544-554. [PMID: 34849286 PMCID: PMC8611271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Coronary no-reflow (NRF) following percutaneous coronary intervention (PCI) is infrequent but one of the most dreaded complication which results from impaired flow of microvascular bed. It is associated with adverse outcome if flow is not restored. Objective of this study was to find safety, effectiveness and outcome of intracoronary nikorandil (IC) administered using perforated balloon technique (PBT) to reverse NRF. METHOD 2-4 mg of nicorandil was diluted with 5 ml of normal saline and administered using PBT over 5-minute. Its effectiveness was evaluated after 10 minute qualitatively using TIMI flow and quantitatively corrected TIMI frame count (cTFC) method. RESULT Study comprised of 84 patients (out of 1789 patients undergoing PCI between January 2019 and February 2020). Their mean age was 57.8±17.9 years. Following PBT, TIMI III flow was successfully normalized in 71 subjects (84.5%), ten (12%) patients had TIMI II flow and it was not successful in three (3.5%) patients. TIMI flow grade got bettered from 1.03 to 2.58 and cTIMI frame count regressed from 52.9±11 to 16.5±5 (P < 0.001). PBT was well tolerated except short lived drop in blood pressure (n=10; 11.9%). CONCLUSION This study, for the first time to the best our knowledge, demonstrated that PBT mediated intracoronary administration of nikorandil distally was rapid, safe, and efficacious method to deal with NRF.
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Affiliation(s)
- Santosh K Sinha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Prakash Kumar
- Department of Cardiology, Rajendra Institute of Medical ScienceJharkhand, India
| | - Awadesh K Sharma
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Mahmodullah Razi
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Mohit Sachan
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Praveen Shukla
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | | | - Mukesh J Jha
- Department of Cardiology, Sri Aurobindo Institute of Medical SciencesIndore, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
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Geng N, Ren L, Xu L, Zou D, Pang W. Clinical outcomes of nicorandil administration in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2021; 21:488. [PMID: 34629058 PMCID: PMC8504118 DOI: 10.1186/s12872-021-02301-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention is the treatment of choice in ST-segment elevation myocardial infarction and no-reflow phenomenon is still an unsolved problem. METHODS We searched PubMed, EmBase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. The primary endpoint was the incidence of major adverse cardiac events and the secondary endpoint was the incidences of no-reflow phenomenon and complete resolution of ST-segment elevation. RESULTS Eighteen randomized controlled trials were enrolled. Nicorandil significantly reduced the incidence of no-reflow phenomenon (OR, 0.46; 95% CI, 0.36-0.59; P < 0.001; I2 = 0%) and major adverse cardiac events (OR, 0.42; 95% CI, 0.27-0.64; P < 0.001; I2 = 52%). For every single outcome of major adverse cardiac events, only heart failure and ventricular arrhythmia were significantly improved with no heterogeneity (OR, 0.36; 95% CI, 0.23-0.57, P < 0.001; OR, 0.43; 95% CI, 0.31-0.60, P < 0.001 respectively). A combination of intracoronary and intravenous nicorandil administration significantly reduced the incidence of major adverse cardiac events with no heterogeneity (OR, 0.24; 95% CI, 0.13-0.43, P < 0.001; I2 = 0%), while a single intravenous administration could not (OR, 0.66; 95% CI, 0.40-1.06, P = 0.09; I2 = 52%). CONCLUSIONS Nicorandil can significantly improve no-reflow phenomenon and major adverse cardiac events in patients undergoing primary percutaneous coronary intervention. The beneficial effects on major adverse cardiac events might be driven by the improvements of heart failure and ventricular arrhythmia. A combination of intracoronary and intravenous administration might be an optimal usage of nicorandil.
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Affiliation(s)
- Ning Geng
- Department of Cardiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning Province, China.
| | - Li Ren
- Department of Cardiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning Province, China
| | - Lisheng Xu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University (Hunnan Campus), No. 195, Chuangxin Street, Hunnan District, Shenyang City, Liaoning Province, China
| | - Deling Zou
- Department of Cardiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning Province, China
| | - Wenyue Pang
- Department of Cardiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning Province, China
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Wang ZD, Li H, Liu M, Li P, Chen J, Liang XW, Zhu XZ, Liao W. Effect of intravenous application of nicorandil on area of myocardial infarction in patients with STEMI during the perioperative stage of PCI. Clin Hemorheol Microcirc 2021; 77:411-423. [PMID: 33386796 DOI: 10.3233/ch-200998] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness and safety of nicorandil in improving the area of myocardial infarction in patients with acute myocardial infarction (AMI). METHODS One hundred and twenty patients with acute ST-segment elevation myocardial infarction (STEMI) admitted to our hospital between December 1, 2018 and December 31, 2019 were selected and randomly allocated to the experimental group (group A, n = 60) and the control group (group B, n = 60). In the experimental group, an infusion of nicorandil was given intravenously before the first balloon dilation or 1 minute before the stent placement, and with the completion of the infusion, nicorandil maintenance infusion was given. In the control group, only balloon dilation and stent placement were undertaken. RESULTS The postoperative peak levels of myoglobin, creatine kinase isoform and hypersensitive troponin T were significantly lower in group A than in group B (p < 0.05). Moreover, the left ventricular ejection fraction (LVEF) on the 180th day post operation was substantially greater in group A than in group B (p < 0.01), and the area of myocardial infarction was significantly smaller in patients in group A than those in group B on the 180th day post operation (p < 0.01). In terms of the safety, there were no statistically significant differences in the incidence of slow flow/no reflow, malignant arrhythmias, and hypotension within 24 hours post operation between the two groups (p > 0.05), and no major adverse cardiovascular event (MACE) occurred in either group during the postoperative follow-up period of 180 days (p > 0.05). CONCLUSION Intravenous administration of nicorandil in patients with STEMI during the perioperative percutaneous coronary intervention (PCI) period was effective in reducing the area of myocardial infarction and myocardial injury without increasing the incidence of malignant arrhythmias, hypotension, or composite cardiovascular events during the drug administration period.
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Affiliation(s)
- Zheng-Dong Wang
- Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Hao Li
- Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Ming Liu
- Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Ping Li
- Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Jian Chen
- Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Xiang-Wen Liang
- Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Xian-Zhang Zhu
- Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
| | - Wang Liao
- Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China
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Zhou J, Xu J, Cheng A, Li P, Chen B, Sun S. Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis. J Int Med Res 2021; 48:300060520967856. [PMID: 33249959 PMCID: PMC7708727 DOI: 10.1177/0300060520967856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective There is controversy whether nicorandil treatment has cardioprotective effects in patients with acute myocardial infarction (AMI) following percutaneous coronary intervention (PCI). This meta-analysis was conducted to assess the efficacy of nicorandil on functional and clinical outcomes after PCI. Methods Systematic databases were searched to retrieve studies that compared the effect of nicorandil with a control group in patients with AMI who underwent PCI. Outcomes related to coronary blood flow, and functional and clinical outcomes were extracted and a meta-analysis was performed. Trial sequential analysis was conducted to estimate the required sample size for statistical power. Results Twenty-four trials involving 2965 patients with AMI were enrolled. Pooled results showed that nicorandil treatment significantly suppressed the incidence of no-reflow phenomenon and reperfusion arrhythmia after reperfusion, improved the left ventricular ejection fraction and left ventricular end-systolic volume index, and reduced major adverse cardiovascular events and cardiovascular death. Trial sequential analysis confirmed the effect of nicorandil in reducing the incidence of no-reflow phenomenon and follow-up major adverse cardiovascular events in patients with AMI after PCI. Conclusion Our findings suggest that nicorandil treatment adjunctive to reperfusion therapy improves myocardial reperfusion, cardiac function, and clinical outcomes in patients with AMI.
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Affiliation(s)
- Jin Zhou
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jing Xu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Aijuan Cheng
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Peng Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Bingwei Chen
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Shan Sun
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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Li W, Zhang G. Impact of administration of nicorandil prior to percutaneous coronary intervention in treatment of acute myocardial infarction: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25565. [PMID: 33907105 PMCID: PMC8084019 DOI: 10.1097/md.0000000000025565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the efficacy and safety of nicorandil prior to percutaneous coronary intervention in acute myocardial infarction (AMI) patients. METHODS This systematic review and meta-analysis will be performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently will search randomized controlled trials or observational studies about the treatment of nicorandil on AMI patients. Retrieved databases include Web of Science, ClinicalTrials.gov, Pubmed, Embase, and Cochrane Library. And retrieval time is limited from inception to June 2021. Key words are nicorandil, myocardial infarction, or similar expansion words without publication limitation. Biomechanical studies, in vitro studies, review articles, techniques, case reports, letters to the editor, and editorials are excluded. RESULTS The results of our review will be reported strictly following the PRISMA criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. OSF REGISTRATION NUMBER 10.17605/OSF.IO/UEPKB.
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Affiliation(s)
- Weijun Li
- Department of Cardiovascular Medicine
| | - Guozhi Zhang
- Health Management Center, Affiliated Hospital of Xiangnan University, Hunan, China
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An S, Huang H, Wang H, Jiang Y. Prophylactically injection of Nicorandil to reduce no-reflow phenomenon during PCI in acute STEMI patients: Protocol of a double-blinded, randomized, placebo-controlled trial. Medicine (Baltimore) 2021; 100:e25500. [PMID: 33847663 PMCID: PMC8052050 DOI: 10.1097/md.0000000000025500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION An acute ST-elevation myocardial infarction (STEMI) is a very serious type of heart attack and a profoundly life-threatening medical emergency, and percutaneous coronary intervention (PCI) is the preferred strategy. However, in patients undergoing primary PCI, 30% to 40% may suffer the no-reflow phenomenon (NRP), and it could expand the myocardial infarction area and accompanied with high rehospitalization rate and fatality rate. In this study, we try to conduct a double blinded, randomized, placebo-controlled trial to observe whether the prophylactically intracoronary administration of Nicorandil could reduce the occurrence of NRP in STEMI patients undergoing PCI. METHODS Simple randomization in a 1:1 ratio will be made in blocks of variable size according to a random numbers generated by Excel 2010 to divide the patients to treatment group (Nicorandil) and control group (Saline). The outcomes are the occurrence of NRP, levels of interleukin-6 and HS-CRP, cTnT, and CK-MB before, and every 4 hours following PCI, and major adverse cardiovascular events at day 30. SPSS 23.0 (IBM, Chicago, IL) will be used, and P-value < .05 will be considered statistically significant. CONCLUSIONS The findings will determine the efficacy of prophylactically intracoronary administration of Nicorandil to reduce the occurrence of NRP during PCI in acute STEMI patients. TRIAL REGISTRATION OSF Registration number: DOI 10.17605/OSF.IO/QPF3V.
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Intracoronary pressure gradient measurement in acute myocardial infarction patients with the no-reflow phenomenon during primary percutaneous coronary intervention. Chin Med J (Engl) 2020; 133:766-772. [PMID: 32149760 PMCID: PMC7147651 DOI: 10.1097/cm9.0000000000000709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Various experimental and clinical studies have reported on coronary microcirculatory dysfunction (“no-reflow” phenomenon). Nevertheless, pathogenesis and effective treatment are yet to be fully elucidated. This study aimed to measure the intracoronary pressure gradient in the no-reflow artery during emergent percutaneous coronary intervention and explore the potential mechanism of no-reflow. Methods From September 1st, 2018 to June 30th, 2019, intracoronary pressure in acute myocardial infarction patient was continuously measured by aspiration catheter from distal to proximal segment in the Department of Coronary Care Unit, Tianjin Chest Hospital, respectively in no-reflow arteries (no-reflow group) and arteries with thrombolysis in myocardial infarction-3 flow (control group). At least 12 cardiac cycles were consecutively recorded when the catheter was pulled back. The forward systolic pressure gradient was calculated as proximal systolic pressure minus distal systolic pressure. Comparison between groups was made using the Student t test, Mann-Whitney U-test or Chi-square test, as appropriate. Results Intracoronary pressure in 33 no-reflow group and 26 in control group were measured. The intracoronary forward systolic pressure gradient was −1.3 (−4.8, 0.7) and 3.8 (0.8, 8.8) mmHg in no-reflow group and control group (Z = −3.989, P < 0.001), respectively, while the forward diastolic pressure gradient was −1.0 (−3.2, 0) and 4.6 (0, 16.5) mmHg in respective groups (Z = −3.851, P < 0.001). Moreover, the intracoronary forward pressure gradient showed significant difference between that before and after nicorandil medication (Z = −3.668, P < 0.001 in systolic pressure gradient and Z = −3.530, P < 0.001 in diastolic pressure gradient). Conclusions No reflow during emergent coronary revascularization is significantly associated with local hemodynamic abnormalities in the coronary arteries. Intracoronary nicorandil administration at the distal segment of a coronary artery with an aspiration catheter could improve the microcirculatory dysfunction and resume normal coronary pressure gradient. Clinical trial registration www.ClinicalTrials.gov (No. NCT 03600259).
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Shi L, Chen L, Qi G, Tian W, Zhao S. Effects of Intracoronary Nicorandil on Myocardial Microcirculation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials. Am J Cardiovasc Drugs 2020; 20:191-198. [PMID: 31423544 DOI: 10.1007/s40256-019-00368-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The amelioration of myocardial reperfusion in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI) remains a significant issue. OBJECTIVE We conducted a meta-analysis of randomized controlled trials (RCTs) to better assess the effects of intracoronary nicorandil administration on myocardial microcirculation and clinical outcomes in these patients. METHODS The meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A literature search was performed in the PubMed, Embase, Cochrane Library, and Web of Science databases up to April 2019, with no time or language limitations. Pooled risk ratios (RRs) were calculated to evaluate the treatment effects. RESULTS Seven RCTs involving a total of 562 patients were included. Compared with control, intracoronary nicorandil significantly reduced the incidence of thrombolysis in myocardial infarction (TIMI) grade ≤ 2 (RR 0.349; 95% confidence interval [CI] 0.199-0.611; P < 0.001) and TIMI myocardial perfusion grade ≤ 2 (RR 0.611; 95% CI 0.438-0.852; P = 0.004) and was associated with higher complete ST-segment resolution rates (RR 1.326; 95% CI 1.090-1.614; P = 0.005). However, no significant benefits were observed on clinical outcomes, including death (RR 0.370; 95% CI 0.085-1.618; P = 0.187), recurrent myocardial infarction (RR 0.507; 95% CI 0.156-1.655; P = 0.261), heart failure (RR 0.528; 95% CI 0.224-1.247; P = 0.145), and target lesion/vessel revascularization (RR 1.109; 95% CI 0.553-2.224; P = 0.770). CONCLUSIONS Intracoronary nicorandil can significantly improve myocardial microcirculation in patients with AMI undergoing PPCI, but it failed to offer clinically significant benefits.
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Xu X, Liu X, Yu L, Ma J, Yu S, Ni M. Impact of intracoronary nicorandil before stent deployment in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Exp Ther Med 2019; 19:137-146. [PMID: 31853283 PMCID: PMC6909796 DOI: 10.3892/etm.2019.8219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 11/07/2019] [Indexed: 12/29/2022] Open
Abstract
The present study aimed to clarify the effect of bolus intracoronary nicorandil on inflammatory, oxidative and adherent indicators in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This randomized controlled trial (RCT) was performed to detect the inflammation and oxidative stress in intracoronary blood both before and after PCI. In total, 65 consecutive patients undergoing PCI were classified into a nicorandil therapy group (n=32) or a placebo group (n=33). All procedures were performed at Shandong University Qilu Hospital, China, during the period from March, 2016 to May, 2017. Intracoronary blood from patients who received nicorandil therapy during PCI showed no change in soluble CD40 ligand (sCD40L) concentration (1.86±0.08 vs. 1.90±0.09 ng/ml, P=0.12) but a significant increase was noted in the control group (1.87±0.17 vs. 2.82±0.26 ng/ml, P<0.01). This indicated a relative reduction in sCD40L level after PCI in the nicorandil group. We further demonstrated an increase in superoxide dismutase (SOD) activity (29.37±0.81 vs. 31.03±0.60 U/ml, P<0.001) and a reduction in lipid peroxidation (3.84±0.99 vs. 4.23±0.13 U/ml, P=0.001) in the nicorandil group but observed no change in the placebo group. ICAM-1 levels showed no change in the nicorandil group (69.54±6.89 vs. 72.01±8.25 ng/ml, P=0.83) but a significant increase in the control group after PCI in intracoronary blood (56.57±4.96 vs. 76.81±6.88 ng/ml, P=0.002). No changes were found in hs-CRP, TNFα and sVCAM-1 levels in coronary blood for both groups before and after PCI in ACS patients. Our findings demonstrate that intracoronary bolus nicorandil therapy has a significant effect on the inhibition of inflammatory indicators and oxidative stress in patients with ACS during PCI. This suggests a possible medical application of nicorandil for reducing inflammation and oxidative stress.
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Affiliation(s)
- Xingli Xu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiaoling Liu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Liwen Yu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jing Ma
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Sufang Yu
- Department of Neurology, The Fourth People's Hospital, Liaocheng, Shandong 252002, P.R. China
| | - Mei Ni
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Zhao XT, Zhang CF, Liu QJ. Meta-analysis of Nicorandil effectiveness on myocardial protection after percutaneous coronary intervention. BMC Cardiovasc Disord 2019; 19:144. [PMID: 31200660 PMCID: PMC6570907 DOI: 10.1186/s12872-019-1071-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/09/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Using the current meta-analysis as well as systematic review, to determine the curative effect of Nicorandil in comparison of no Nicorandil after elective percutaneous coronary intervention(PCI) on patients. METHODS Published literatures were identified via a computerized literature search of CENTRAL, PubMed, Cochrane, Embase Databases of Systematic Reviews. A set of randomized trials evaluating Nicorandil in comparison of no Nicorandil administered following PCI in patients harboring coronary artery disease were included. Outcomes were revealed based on the following parameters: peak creatine kinase-MB (CK-MB) value, left ventricular ejection fraction (LVEF), peak troponin I (cTnI), and major adverse cardiovascular events (MACEs) per randomized patients. RESULTS We included a total of 14 RCTs involving 1864 subjects in the present review. According to this meta-analysis, LVEF was significantly improved in Nicorandil group; the peak CK-MB level and the incidence of adverse cardiovascular events were remarkably lower in Nicorandil group. Nicorandil and no Nicorandil administered group appeared to be equivalent with regards to cTnI. CONCLUSIONS Nicorandil is effective for patients undergoing elective PCI with coronary artery disease in terms of reducing the incidence of adverse cardiovascular events as well as improving heart function. Nicorandil may exert potential role as a valid and adjunctive therapy accompanied with PCI.
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Affiliation(s)
- Xiao-Tao Zhao
- Department of Cardiology, Beijing Chao-Yang Hospital, Captial Medical University, 8 Gongti Nanlu Road, Chaoyang District, Beijing, 100020, NO, China.
| | - Chun-Fei Zhang
- Department of Internal Medicine, General Political Department Hospital of Chinese PLA, Beijing, China
| | - Qing-Jie Liu
- National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Chinese Center for Medical Response to Radiation Emergency, No. 2 Xinkang Street, Deshengmenwai, Beijing, 100088, China.
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Effects of Early Intracoronary Administration of Nicorandil During Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction. Heart Lung Circ 2019; 28:858-865. [DOI: 10.1016/j.hlc.2018.05.097] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/28/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023]
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The effect of nicorandil in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Ir J Med Sci 2019; 189:119-131. [DOI: 10.1007/s11845-019-02034-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/08/2019] [Indexed: 12/24/2022]
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Li J, Xu X, Zhou X, Dai J, Ma L, Chen C, Li X, Mao W. Cardiovascular events associated with nicorandil administration prior to primary percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction: a systematic review and meta-analysis. Expert Opin Drug Saf 2019; 18:537-547. [PMID: 31117845 DOI: 10.1080/14740338.2019.1617848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jiaying Li
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiaoming Xu
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xinbin Zhou
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jin Dai
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lan Ma
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chen Chen
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xinyao Li
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wei Mao
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Xu L, Wang L, Li K, Zhang Z, Sun H, Yang X. Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:1389-1400. [PMID: 31118574 PMCID: PMC6499143 DOI: 10.2147/dddt.s195918] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/21/2019] [Indexed: 12/16/2022]
Abstract
Background: Nicorandil prior to reperfusion by primary percutaneous coronary intervention (PCI) in patients with ST-segment elevated myocardial infarction (STEMI) has been suggested to be beneficial. However, results of previous randomized controlled trials (RCTs) were not consistent. We aimed to perform a meta-analysis to systematically evaluate the effect of periprocedural nicorandil in these patients. Methods: Related studies were obtained by searching PubMed, Embase and Cochrane's Library. Effects of perioperative nicorandil on the incidence of no-reflow phenomenon (NRP), corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC), wall motion score (WMS), left ventricular ejection fraction (LVEF), heart failure (HF) exacerbation of rehospitalization and incidence of major cardiovascular adverse events (MACE) were analyzed. Results: Eighteen RCTs with 2,055 patients were included. Treatment of nicorandil prior to PCI significantly reduced the incidence of NRP (risk ratio [RR]: 0.47, P<0.001), and reduced CTFC (weighed mean difference [WMD]: -4.54, P<0.001) immediately after PCI. Moreover, although nicorandil did not significantly affect WMS (WMD: 0.04, P=0.91), treatment of nicorandil significantly increased LVEF in STEMI patients undergoing primary PCI (WMD: 1.89%, P<0.001). In addition, nicorandil significantly reduced the risk of HF exacerbation or rehospitalization (RR: 0.44, P=0.001) and the incidence of MACE (RR: 0.68, P<0.001). Further analyses showed that effects of nicorandil on LVEF, HF exacerbation and MACE were consistent within one month after PCI and during follow-up. Conclusions: Periprocedural nicorandil improves coronary blood flow, cardiac systolic function and prognosis in STEMI patients receiving primary PCI.
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Affiliation(s)
- Li Xu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Lefeng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Kuibao Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Zhiyong Zhang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Hao Sun
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Xinchun Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
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Pi SF, Liu YW, Li T, Wang Y, Zhou Q, Liu BJ, Peng WJ, Li X, Wang YY, Huang L. Effect of sequential nicorandil on myocardial microcirculation and short-term prognosis in acute myocardial infarction patients undergoing coronary intervention. J Thorac Dis 2019; 11:744-752. [PMID: 31019762 DOI: 10.21037/jtd.2019.02.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background This study aims to observe the effects of the intracoronary and peripheral venous administration of nicorandil for the postoperative myocardial microcirculation and short-term prognosis of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) treatment. Methods A total of 140 STEMI patients were divided into three groups according to different patterns of administration: sequential nicorandil group, intracoronary nicorandil group and control group. The main observation indexes included coronary blood flow and myocardial perfusion immediately after PPCI, while the secondary observation indexes included major adverse cardiovascular events (MACE) and left ventricular ejection fraction (LVEF) during the period of hospitalization. Results After PPCI, the difference in the proportion of patients with thrombolysis in myocardial infarction (TIMI) flow grade 3 among the three groups was statistically significant (P=0.036), where this proportion was higher in the sequential nicorandil group and intracoronary nicorandil group than in the control group (P=0.022 and P=0.047); The difference in corrected TIMI frame count (CTFC) among the three groups was statistically significant (P=0.022), where CTFC was lower in the sequential nicorandil group and intracoronary nicorandil group than in the control group (P=0.010, P=0.031); The differences in the proportion of patients with complete ST resolution (STR) and advancing of enzyme peak time to within 12 h between each two groups were statistically significant (P<0.001), where this proportion was the highest in the sequential nicorandil group; The difference in the CK-MB peak among the three groups was statistically significant (P=0.036), where the CK-MB peak was lower in the sequential nicorandil group than in the control group (P=0.012); The difference in the incidence of MACE between each two groups was statistically significant (P<0.001), where this incidence was the lowest in the sequential nicorandil group; The differences in the proportion of patients with advancing of enzyme peak time to within 14 h and LVEF among the three groups were not statistically significant (P=0.722 and P=0.284). Conclusions Compared with intracoronary use alone, the intracoronary and peripheral intravenous use of nicorandil can better improve myocardial microcirculation and short-term prognosis.
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Affiliation(s)
- Shu-Fang Pi
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Ying-Wu Liu
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Tong Li
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Yu Wang
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Quan Zhou
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Bo-Jiang Liu
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Wen-Jin Peng
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Xin Li
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Yun-Yun Wang
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Lei Huang
- Department of Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
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Effect of nicorandil administration on myocardial microcirculation during primary percutaneous coronary intervention in patients with acute myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:26-31. [PMID: 29743901 PMCID: PMC5939542 DOI: 10.5114/aic.2018.74352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/30/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Prevention of the no-reflow phenomenon has a crucial role in primary percutaneous coronary intervention (P-PCI) procedures. Aim To assess the effects of early intracoronary administration of nicorandil (NIC) during P-PCI on myocardial microcirculation in patients with acute myocardial infarction (AMI). Material and methods A total of 120 patients with first acute anterior wall ST segment elevation myocardial infarction who underwent P-PCI were randomly divided into two groups: the NIC group (A, n = 60) and the placebo group (B, n = 60). Before stent placement, NIC or normal saline was injected using a guiding catheter. The thrombolysis in myocardial infarction (TIMI) grade, TIMI myocardial perfusion grade (TMPG), resolution of ST segment elevation (defined as > 50% decrease in ST elevation) 1 h after surgery, and 99Tcm-methoxyisobutyl isocyanide (MIBI) rest myocardial perfusion imaging (MPI) via single-photon emission computed tomography (99Tcm-MIBI SPECT) findings 10 days after surgery were compared between the two groups. Results The number of patients who achieved TIMI grade 3 (96.67% vs. 86.67%; p = 0.047) and TMPG 3 (95% vs. 83.33%; p = 0.040) was higher in the NIC group than in the placebo group. Resolution of ST segment elevation occurred in 95% and 81.67% of the patients in the NIC and placebo groups, respectively (p = 0.023); the MPI score of the two groups was 4.1 ±1.89 and 7.3 ±2.65, respectively (p = 0.014). Conclusions Early coronary administration of NIC can significantly reduce the damage in the myocardial microcirculation caused by P-PCI and the myocardial infarct size in patients with AMI.
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Qi Q, Niu J, Chen T, Yin H, Wang T, Jiang Z. Intracoronary Nicorandil and the Prevention of the No-Reflow Phenomenon During Primary Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction. Med Sci Monit 2018; 24:2767-2776. [PMID: 29726480 PMCID: PMC5954842 DOI: 10.12659/msm.906815] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to investigate intracoronary nicorandil treatment on the no-reflow phenomenon (NRP) during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) and to compare nicorandil with sodium nitroprusside. Material/Methods Patients with sustained acute STEMI who underwent primary PCI (N=120) were randomly assigned to three groups: the nicorandil-treated group (N=40) had 2 mg of nicorandil injected into the coronary artery at 2 mm beyond the occlusion with balloon pre-dilation; the sodium nitroprusside-treated group (N=40) underwent the same procedure, but with 200 μg of sodium nitroprusside; the control group (N=40) received PCI and balloon pre-dilation only. Coronary angiography, incidence of NRP, hypotensive episodes, ST-segment resolution (STR) rate, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), cardiac troponin I (cTnI), wall motion score index (WMSI), and left ventricular ejection fraction (LVEF) were measured before and after primary PCI. Major adverse cardiovascular events (MACEs) post-PCI and at three-month follow-up were recorded. Results Patients in the sodium nitroprusside and nicorandil groups had significantly improved thrombolysis in myocardial infarction (TIMI) scores, TIMI myocardial perfusion grade (TMPG), and ST-segment elevation resolution (STR) (P<0.05), and a significantly lower incidence of NRP (P=0.013). The incidence of intraoperative hypotension in the sodium nitroprusside group was significantly greater than the nicorandil and control groups (P=0.035). Conclusions Patients with sustained acute STEMI undergoing primary PCI, treated with intracoronary nicorandil had a reduced incidence of the NRP, improved myocardial perfusion and cardiac function.
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Affiliation(s)
- Qi Qi
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jinghui Niu
- Department of Orthopedics, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Tao Chen
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Hongshan Yin
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Tao Wang
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Zhian Jiang
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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Niu X, Zhang J, Bai M, Peng Y, Sun S, Zhang Z. Effect of intracoronary agents on the no-reflow phenomenon during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: a network meta-analysis. BMC Cardiovasc Disord 2018; 18:3. [PMID: 29320987 PMCID: PMC5763527 DOI: 10.1186/s12872-017-0722-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 11/28/2017] [Indexed: 02/06/2023] Open
Abstract
Background Despite the restoration of epicardial flow after primary percutaneous coronary intervention (PPCI), myocardial reperfusion remains impaired in a significant proportion of patients. We performed a network meta-analysis to assess the effect of 7 intracoronary agents (adenosine, anisodamine, diltiazem, nicorandil, nitroprusside, urapidil, and verapamil) on the no-reflow phenomenon in patients with ST-elevation myocardial infarction (STEMI) undergoing PPCI. Methods Database searches were conducted to identify randomized controlled trials (RCTs) comparing the 7 agents with each other or with standard PPCI. Outcome measures included thrombolysis in myocardial infarction flow grade (TFG), ST-segment resolution (STR), left ventricular ejection fraction (LVEF), major adverse cardiovascular events (MACEs), and adverse events. Results Forty-one RCTs involving 4069 patients were analyzed. The addition of anisodamine to standard PPCI for STEMI was associated with improved post-procedural TFG, more occurrences of STR, and improvement of LVEF. The cardioprotective effect of anisodamine conferred a MACE-free survival benefit. Additionally, nitroprusside was regarded as efficient in improving coronary flow and clinical outcomes. Compared with standard care, adenosine, nicorandil, and verapamil improved coronary flow but had no corresponding benefits regarding cardiac function and clinical outcomes. The ranking probability for the 7 treatment drugs showed that anisodamine consistently ranked the highest in efficacy outcomes (TFG < 3, STR, LVEF, and MACEs). No severe adverse events, such as hypotension and malignant arrhythmia, were observed in patients treated with anisodamine. Network meta-regression analysis showed that age, the time to reperfusion, and study follow-up did not affect the treatment effects. Conclusions The intracoronary administration of anisodamine appears to improve myocardial reperfusion, cardiac function, and clinical outcomes in patients with STEMI undergoing PPCI. Given the limited quality and quantity of the included studies, more rigorous RCTs are needed to verify the role of this inexpensive and well-tolerated regimen. Electronic supplementary material The online version of this article (10.1186/s12872-017-0722-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaowei Niu
- The First School of Clinical Medicine, Lanzhou University, Tianshui South Road, No. 222, Lanzhou, Gansu, 730000, China
| | - Jingjing Zhang
- Baiyin Second People's Hospital, Gongyuan Road, No. 509, Baiyin, Gansu, 730900, China
| | - Ming Bai
- Department of Cardiology, the First Hospital of Lanzhou University, Donggang West Road, No. 1, Lanzhou, Gansu, 730000, China
| | - Yu Peng
- Department of Cardiology, the First Hospital of Lanzhou University, Donggang West Road, No. 1, Lanzhou, Gansu, 730000, China
| | - Shaobo Sun
- Key Lab of Prevention and Treatment for Chronic Disease, Gansu University of Chinese Medicine, Dingxi East Road, No. 35, Lanzhou, Gansu, 730000, China
| | - Zheng Zhang
- Department of Cardiology, the First Hospital of Lanzhou University, Donggang West Road, No. 1, Lanzhou, Gansu, 730000, China.
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Sun B, Liu Z, Yin H, Wang T, Chen T, Yang S, Jiang Z. Intralesional versus intracoronary administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndromes: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96:e8223. [PMID: 28984776 PMCID: PMC5738012 DOI: 10.1097/md.0000000000008223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Glycoprotein IIb/IIIa inhibitors (GPIs) have been regarded as an adjuvant regimen to deal with no-reflow. However, whether intralesional (IL) administration of GPIs improves myocardial reperfusion without increasing bleeding in patients with acute coronary syndrome (ACS) compared with intracoronary (IC) administration has not been well addressed. Our meta-analysis aimed to evaluate the efficacy and safety of IL versus IC administration of GPIs for patients with ACS during percutaneous coronary intervention. METHODS We systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, and Cambridge Scientific Abstracts from January 2007 to May 2017. Thrombolysis in Myocardial Infarction (TIMI) 3 flow, corrected TIMI frame count (CTFC), and complete ST-segment resolution (>70%) were selected as the primary outcomes. Major adverse cardiac events (MACEs) were the secondary outcome, and major bleeding complications were the safety outcome. Data analysis was conducted using the Review Manager 5.3 software. RESULTS Six randomized controlled trials were included in our meta-analysis. Compared with IC, IL obtained better results in terms of TIMI grade 3 flow [odds ratio (OR) 2.29; 95% confidence intervals (CIs) 1.31-4.01; P = .004], CTFC [weighted mean difference (WMD) -4.63; 95% CI -8.82 to -0.43; P = .03], and complete ST-segment resolution (OR 1.55; 95% CI 1.12-2.14; P = .008). There was a trend toward decreased MACE in the IL administration groups, which was not of statistical significance (OR 0.63; 95% CI 0.30-1.31; P = .22). No significant difference was found between the two groups in terms of in-hospital major bleeding events (OR 2.52; 95% CI .66 to 9.62; P = .18). CONCLUSION IL administration yielded favorable outcomes in terms of myocardial tissue reperfusion as evidenced by the improved TIMI flow grade, CTFC, complete ST-segment resolution, and decreased MACE without increasing in-hospital major bleeding events. The IL administration of GPIs can be recommended as the preferred regimen to guard against no-reflow.
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Affiliation(s)
- Binjie Sun
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Zhen Liu
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Hongshan Yin
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Tao Wang
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Tao Chen
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Sen Yang
- Department of Epidemiology and Health Statistics, Center for Disease Control and Prevention of Hebei Province, Shijiazhuang, P.R. China
| | - Zhian Jiang
- Department of Cardiology, The Third Hospital of Hebei Medical University
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