Nicorandil improves PCI outcomes in STEMI patients

In patients with ST‐segment–elevation myocardial infarction (STEMI), treatment with nicorandil prior to undergoing primary percutaneous coronary intervention (PCI) may result in improved myocardial perfusion grade, increased left ventricular ejection fraction, and reduced myocardial infarct size, according to data from the CHANGE* study.

CHANGE randomized 238 STEMI patients to receive intravenous nicorandil (n=120) or placebo (n=118) before reperfusion. Nicorandil was administered as a 6‐mg intravenous bolus followed by continuous infusion at a rate of 6 mg/h. The same dose of placebo was given in the control group. The primary endpoint was infarct size on cardiac magnetic resonance (CMR) imaging performed at 5–7 days and 6 months after reperfusion.

A total of 201 patients (84 percent) had CMR imaging data. Those who received nicorandil had significantly smaller infarct size on CMR imaging at 5 to 7 days after reperfusion compared with patients in the control group (mean 26.5 vs 32.4 g; p=0.022), and this effect remained significant on CMR imaging at 6 months after reperfusion (mean 19.5 vs 25.7 g; p=0.008).

Moreover, nicorandil was associated with a lower incidence of no‐reflow/slow‐flow phenomenon during primary PCI (9.2 percent vs 26.3 percent; p=0.001), which led to a higher rate of complete ST‐segment resolution than in the control group (90.8 percent vs 78.0 percent; p=0.006).

Finally, left ventricular ejection fraction on CMR imaging was markedly higher in the nicorandil group than in the control group at both 5–7 days (mean 47.0 percent vs 43.3 percent; p=0.011) and 6 months (mean 50.1 percent vs 46.4 percent; p=0.009) after reperfusion.

*Effects of Nicorandil Administration on Infarct Size in Patients With ST‐Segment–Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention