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The Effect of Pharmacological Preconditioning with Nicorandil before Elective Coronary Stenting on the Long-Term Prognosis of Patients with Stable Coronary Artery Disease

https://doi.org/10.20996/1819-6446-2020-04-05

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Abstract

Aim. To study nicorandil prescription effects before elective percutaneous coronary intervention (PCI) to prevent myocardial injury and 4a type acute myocardial infarction (MI, primary endpoint) and cardiovascular events (CVE) in the first year after PCI (secondary endpoint) in patients with stable coronary artery disease.

Material and methods. 182 patients with stable coronary artery disease were included into the study and were randomized into two groups: nicorandil treatment group (n=90) and a control group with a standard medical treatment (n=92). Nicorandil was prescribed orally: 2 days before PCI – 30 mg/day; on the day of PCI – 20 mg 2 hours before intervention and 10 mg 6-12 hours after PCI; over the next 30 days – 30 mg/day. High sensitivity troponin I (hs-Tr) and creatine kinase-MB tests were carried out before PCI, 24 and 72 hours after the intervention; the 4a type MI was diagnosed according to the 4th Universal Definition. Non-fatal myocardial infarction, nonfatal stroke, death from cardiovascular diseases, repeat revascularization (PCI, coronary artery bypass surgery due to aggravation), hospital admissions for angina pectoris recurrence (without interventions) and death from any causes were considered as cardiovascular events. Data on adverse outcomes were collected over the hospital stay, and then 30, 180 and 365 days after the hospital discharge.

Results. 4a type MI was diagnosed in 14 patients (8%), in women – 12% and in men – 6%. There was a significant decrease in the incidence of type 4a MI in the nicorandil group (n=3; 3%) compared with the control group (n=11; 12%; p=0.05). Secondary endpoint was recorded in 21% of patients. The relationship was found between 4a type MI and the incidence of CVE the next year after the PCI (p=0.01). In patients with type 4a MI CVE odd ratio increases 5.8 times with confidence interval from 1.5426 to 21.6024. According to the logistic regression analysis the significant relationship between hs-Tr growth 24 hours after the PCI and CVE incidence next year after the PCI was found with cutting value 389.8 pg/ml, AUC=0.641 (p=0.04).

Сonclusion. Peroral nicorandil 30 mg/day 2 days before PCI, 20 mg 2 hours before surgery and 10 mg 6-12 hours after PCI, and 30 mg/day next 30 days after PCI decreases the risk of intraoperative myocardial injury and CVE in the next year after PCI.

About the Authors

G. N. Soboleva
National Medical Research Centre of Cardiology
Russian Federation

Galina N. Soboleva – MD, PhD, Leading Researcher, Angiology Department, Research Institute of Clinical Cardiology named after A.L. Myasnikov

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



R. V. Gostishchev
“Novomoskovsky” Medical Center
Russian Federation

Roman V. Gostishchev – MD, Deputy Head Physician

Sosenskiy Stan ul. 8, pos. Kommunarka, Moscow, 129301



A. N. Rogoza
National Medical Research Centre of Cardiology
Russian Federation

Anatoly N. Rogoza – PhD (biology), Head of New Diagostic Methods Department, Research Institute of Clinical Cardiology named after A.L.Myasnikov

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



T. I. Kotkina
National Medical Research Centre of Cardiology
Russian Federation

Tatyana I. Kotkina – MD, PhD, Physician, Clinical Biochemistry Laboratory, Research Institute of Clinical Cardiology named after A.L. Myasnikov

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



A. N. Samko
National Medical Research Centre of Cardiology
Russian Federation

Anatoly N. Samko – MD, PhD, Head of Endovascular Diagnostic and Treatment Methods, Research Institute of Clinical Cardiology named after A.L. Myasnikov

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



Yu. A. Karpov
National Medical Research Centre of Cardiology
Russian Federation

Yurii A. Karpov – MD, PhD, Head of Angiology Department, Research Institute of Clinical Cardiology named after A.L. Myasnikov

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



References

1. Califf R.M., Abdelmeguid A.E., Kuntz R.E., et al. Myonecrosis after revascularization procedures. J Am Coll Cardiol. 1998;31:241-51. DOI:10.1016/s0735-1097(97)00506-8.

2. Lindsey J.B., Marso S.P., Pencina M., et al. Prognostic impact of periprocedural bleeding and myocardial infarction after percutaneous coronary intervention in unselected patients: results from the EVENT (evaluation of drug-eluting stents and ischemic events) registry. JACC Cardiovasc Interv. 2009;2:1074- 82. DOI:10.1016/j.jcin.2009.09.002.

3. Sakata Y., Nakatani D., Shimizu M., et al. Oral treatment with nicorandil at discharge is associated with reduced mortality after acute myocardial infarction. J Cardiol. 2012;59(1):14-21. DOI:10.1016/j.jjcc.2011.08.001.

4. IONA Study Grup. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA):randomized trial. Lancet. 2002;359(9314):1269-75. DOI:10.1016/S0140-6736(02)08265-X.

5. Thygesen K., Alpert J.S., Jaffe A.S., et al., ESC Scientific Document Group; Fourth universal definition of myocardial infarction. Eur Heart J. 2019;40(3):237-69. DOI:10.1093/eurheartj/ehy462.

6. Soboleva G.N., Gostishchev R.V., Rogoza A.N., et al. Nicorandil in the prevention of damage and myocardial infarction of type 4A with planned percutaneous coronary intervention in patients with coronary artery atherosclerosis. Russian Journal of Cardiology. 2019;5:44-51 (In Russ.)

7. Jansen H., Jaensch A., Schöttker B., et al. Repeat Measurements of High Sensitivity Troponins for the Prediction of Recurrent Cardiovascular Events in Patients With Established Coronary Heart Disease: An Analysis From the KAROLA Study. J Am Heart Assoc. 2019;8(12):e011882. DOI:10.1161/JAHA.118.011882.

8. Kawai Y., Hisamatsu K., Matsubara H. et al. Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon. Eur Heart J. 2009;30(7):765-72. DOI:10.1093/eurheartj/ehp077.

9. Lee H.C., An S.G., Choi J.H., et al. Effect of intra-coronary nicorandil administration prior to reperfusion in acute ST segment elevation myocardial infarction. Circ J. 2008;72(9):1425-9. DOI: 10.1253/circj.cj-08-0212.

10. Sakata Y., Nakatani D., Shimizu M., et al. Oral treatment with nicorandil at discharge is associated with reduced mortality after acute myocardial infarction. J Cardiol. 2012;59(1):14-21. DOI:10.1016/j.jjcc.2011.08.001.

11. Yang J., Zhang J., Cui W., et al. Cardioprotective effects of single oral dose of nicorandil before selective percutaneous coronary intervention. Anatolian J Cardiol. 2015;15:125-31. DOI:10.5152/akd.2014.5207.

12. Zhao X.T., Zhang C.F., Liu Q.J. Meta-analysis of Nicorandil effectiveness on myocardial protection after percutaneous coronary intervention. BMC Cardiovasc Disord. 2019;19(1):144. DOI:10.1186/s12872-019-1071-x.

13. Mironova O.Y. Myocardial infarction type 4a. Ter Arkchiv. 2014;9:102-7 (In Russ.) [Миронова О.Ю. Инфаркт миокарда типа 4а. Терапевтический Архив. 2014;9:102-7].

14. Jackson E.A., Moscucci M., Smith D.E., et al. The association of sex with outcomes among patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction in the contemporary era: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Am Heart J. 2011;161:106-12e1. DOI:10.1016/j.ahj.2010.09.030.

15. Chichareon P., Modolo R., Kerkmeijer L., et al. Association of Sex With Outcomes in Patients Undergoing Percutaneous Coronary Intervention: A Subgroup Analysis of the GLOBAL LEADERS Randomized Clinical Trial. JAMA Cardiol. 2019;6:1-10. DOI:10.1001/jamacardio.2019.4296.

16. Cantor W.J., Miller J.M., Hellkamp A.S., et al. Role of target vessel size and body surface area on outcomes after percutaneous coronary interventions in women. Am Heart J. 2002;144:297-302. DOI:10.1067/mhj.2002.123318.

17. Mahajan A.M., Claessen B.E., Chandrasekhar J., et al. Outcomes by Gender and Ethnicity After Percutaneous Coronary Intervention. Am J Cardiol. 2019;123(12):1941-8. DOI:10.1016/j.amjcard.2019.03.019.

18. Hirohata A., Yamamoto K., Hirose E., et al. Nicorandil prevents microvascular dysfunction resulting from PCI in patients with stable angina pectoris: a randomised study. EuroIntervention. 2014;9(9):1050-6. DOI:10.4244/EIJV9I9A178.

19. Zeitouni M., Silvain J., Guedeney P., et al.; ACTION Study Group. Periprocedural myocardial infarction and injury in elective coronary stenting. Eur Heart J. 2018;39:1100-9. DOI:10.1093/eurheartj/ehx799.


For citation:


Soboleva G.N., Gostishchev R.V., Rogoza A.N., Kotkina T.I., Samko A.N., Karpov Yu.A. The Effect of Pharmacological Preconditioning with Nicorandil before Elective Coronary Stenting on the Long-Term Prognosis of Patients with Stable Coronary Artery Disease. Rational Pharmacotherapy in Cardiology. 2020;16(2):191-198. (In Russ.) https://doi.org/10.20996/1819-6446-2020-04-05

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)