Nicorandil Applications in Cardiovascular Interventions
Summary
Nicorandil is a hybrid therapeutic combining nitrate-like vasodilatation with mitochondrial ATP-sensitive potassium channel opening. This dual mechanism underpins its cardioprotective effects across a range of clinical settings, notably during percutaneous coronary intervention (PCI). By improving coronary microcirculation and attenuating ischaemia–reperfusion injury, nicorandil reduces myocardial injury, limits infarct size and mitigates arrhythmias. Its anti-ischaemic action is observed in stable coronary artery disease as well as in acute ST-elevation myocardial infarction. Administration routes include intracoronary bolus, intravenous infusion and oral dosing. In elective PCI, nicorandil preconditioning diminishes biochemical markers of peri-procedural injury and lowers adverse event rates. In primary PCI for acute myocardial infarction, nicorandil lessens no-reflow phenomena, improves coronary flow reserve and supports left ventricular function. Beyond interventional cardiology, nicorandil has shown promise in preventing endothelial dysfunction in diabetes and attenuating vascular remodelling after balloon injury.
Research from Nature Portfolio
A seminal meta-analysis examined nicorandil as an adjunct to elective PCI and confirmed significant reductions in peri-procedural myocardial injury markers and adverse reactions. The analysis demonstrated lower levels of creatine kinase-MB and troponin T in patients receiving nicorandil, alongside a decrease in post-PCI complications. Subgroup assessment suggested variable efficacy across different populations, highlighting the need for further prospective studies to clarify demographic influences on protection. This work remains foundational in establishing nicorandil’s role in myocardial protection during elective coronary interventions.
Nicorandil Applications in Cardiovascular Interventions publication trend
The graph below shows the total number of articles in nicorandil applications in cardiovascular interventions across all publications each year (not limited to Nature Index journals).
Technical terms
Percutaneous coronary intervention (PCI): A catheter-based procedure used to open narrowed coronary arteries.
No-reflow phenomenon: Impaired microvascular perfusion despite removal of epicardial coronary obstruction.
Major adverse cardiac events (MACE): A composite endpoint including death, myocardial infarction and need for repeat revascularisation.
Microvascular resistance (IMR): An invasive measure of coronary microcirculatory function.
Coronary flow reserve (CFR): The ratio of maximal to resting coronary blood flow, indicating microvascular health.
Mitochondrial ATP-sensitive potassium (mitoKATP) channels: Channels regulating mitochondrial membrane potential, integral to ischaemic preconditioning.
References
- The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis. Scientific Reports (2017).
- The Efficacy and Safety of Nicorandil for Periprocedural Myocardial Injury in Patients Undergoing PCI: A Meta‐Analysis. Journal of Interventional Cardiology (2020).
- 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 Cardiovascular Disorders (2021).
- Nicorandil prevents endothelial dysfunction due to antioxidative effects via normalisation of NADPH oxidase and nitric oxide synthase in streptozotocin diabetic rats. Cardiovascular Diabetology (2011).
- Nicorandil attenuates carotid intimal hyperplasia after balloon catheter injury in diabetic rats. Cardiovascular Diabetology (2016).
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