Pharmacological preconditioning by Nicorandil in prevention of ischaemic myocardial injury during an elective percutaneous coronary intervention

Abstract Introduction Elective percutaneous coronary intervention (PCI) is accompanied by intraoperative ischemic myocardial injury (IIMI) up to 30% of the cases despite successfully performed procedure. Pharmacological preconditioning can prevent IIMI; Nicorandil is considered promising for this purpose. Purpose To study the possibility of pharmacological preconditioning by oral Nicorandil to ptevent ischaemic myocardial injury and 4a type myocardial infarction (MI) in patients with a stable form of coronary artery disease (CAD) before PCI. Material and methods 182 patients with CAD and indications for PCI were randomized into two groups: Nicorandil treatment group (additionally to β-blockers and a calcium channel blockers, n=90) and the control group (β-blockers and a calcium channel blockers, n=92). Nicorandil per os was prescribed 2 days before the PCI (30 mg/day); on the day of PCI – 2 hours before intervention (20 mg), 6–12 hours after PCI – 10 mg. The analysis of hs-Troponin I (hs-Tr) and creatine phosphokinase-MB (CK-MB)was carried out before PCI and 24, 72 hours after the procedure. The diagnosis of MI 4a type was established according to fourth universal definition. Double antiplatelet therapy was prescribed to all patients. Results Clinical profile (age, BMI, BP, creatinin clearance, LDL-cholesterol, glucose) of the patient groups were comparable by the basic parameters. The rate of hs-Tr after 24 hours has approached the 99th percentile from the upper limit of normal in 146 patients (80%). The increment of mean level of hs-Tr 24 hours after PCI has not distinguish statistically between the Nicorandil and the control group (364 vs 725 pg/ml, p=0,1). Mean of CK-MB increment in the control group has approached 2,5 ng/ml vs 0,5 ng/ml in the Nicorandil group (p=0.06). Among women (n=61), the increment of hs-Tr in 24 hours after PCI was statistically significantly lower (287 vs 1135 pg/ml, p=0,04) in the Nicorandil group compared to the control group. MI 4a type was detected in 12% of patients in the control group, and it decreased to 3% of patients in the Nicorandil group (p=0,05), it was observed in 21% in women in the control group and in 3% in the Nicorandil group. Conclusion Nicorandil treatment using before PCI decreases the risk of MI 4a in patients with a stable CAD due to the realization of pharmacological preconditioning. Funding Acknowledgement Type of funding source: None