The implementation of cardioprotection with nicorandil from periprocedural damage during elective percutaneous coronary interventions in patients with stable coronary heart disease
- Authors: Gostishchev R.V1, Soboleva G.N1, Samko A.N1, Minasyan A.A1
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Affiliations:
- A.L.Myasnikov Institute of Clinical Cardiology National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation
- Issue: Vol 20, No 5 (2018)
- Pages: 61-65
- Section: Articles
- URL: https://journals.rcsi.science/2075-1753/article/view/95006
- DOI: https://doi.org/10.26442/2075-1753_2018.5.61-65
- ID: 95006
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Abstract
The purpose of the study is to demonstrate such an effect of the nicorandil like the pharmacological preconditioning in patients with stable coronary heart disease (CHD) during elective percutaneous coronary intervention (PCI). Material and methods. The study included 88 patients with a stable form of CHD directed to the elective PCI. By the method of blind randomization (envelope method) two groups or patients were formed: 45 patients in the first group (main group) - for treatment with nicorandil (Cordinic, PIQ-FHARMA LLC) and 43 patients in the second group for standard therapy (comparison group). In both groups the basic antianginal therapy was allowed - b-blockers, calcium antagonists, ATE inhibitors/angiotensin II receptor blockers, statins, acetylsalicylic acid, blockers of P2Y12 receptor platelets. In the second group was allowed the admission of prolonged form of nitrates before PCI. Patients of the 1st group took nicorandil 2 days prior to PCI at a dose of 30 mg/day, 2 hours before PCI - 20 mg orally, after 6 hours after PCI - 10 mg nicorandil. Highly sensitive troponin (HS-Tn) as a biomarker of irreversible damage to the myocardium was evaluated before PCI and after PCI in 24 hours. Results. The obtained data shows the significant increase in HS-Tn in 24 hours after PCI in patients with no admission of nicorandil (117 ng/l) as compared with the nicorandil group (73 ng/l), p=0.04. There were significant differences in the 24 hours increment in HS-Tn in the control group, it was higher (112 ng/l) than in the nicorandil group (67 ng/l), p=0.03. Also the frequency of the troponin increase above the upper normal level in the nicorandal group, was significantly (p=0.03) lower (in 62% of cases compared to 85% of the control group). The conclusion. The protective effect of the oral form of nicorandil admission on the reduction of damage to cardiomyocytes during the elective PCI is a clinically proven effect of pharmacological preconditioning of this drug, which will expand the indications for its purpose in the strategy of drug support of PCI in patients with stable CHD.
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##article.viewOnOriginalSite##About the authors
R. V Gostishchev
A.L.Myasnikov Institute of Clinical Cardiology National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation
Email: gostiroman@gmail.com
аспирант отд. рентгенэндоваскулярных методов диагностики и лечения; Институт клинической кардиологии им. А.Л.Мясникова 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
G. N Soboleva
A.L.Myasnikov Institute of Clinical Cardiology National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federationд-р мед. наук, вед. науч. сотр. отд. ангиологии; Институт клинической кардиологии им. А.Л.Мясникова 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
A. N Samko
A.L.Myasnikov Institute of Clinical Cardiology National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federationд-р мед. наук, проф., рук. отд. рентгенэндоваскулярных методов диагностики и лечения; Институт клинической кардиологии им. А.Л.Мясникова 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
A. A Minasyan
A.L.Myasnikov Institute of Clinical Cardiology National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federationординатор; Институт клинической кардиологии им. А.Л.Мясникова 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
References
- Fox K, Garcia M.A, Ardissino D et al. Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006; 27 (11): 1341-81.
- Марцевич С.Ю., Кутишенко Н.П., Деев А.Д. от имени участников исследования КВАЗАР. Сравнительная оценка антиангинальной эффективности и безопасности препарата никорандил на фоне базисной терапии b-адреноблокаторами у больных ишемической болезнью сердца со стабильной стенокардией. Кардиология. 2016; 10: 30-4. DOI: http://dx.doi.org/10.18565/cardio.2016.10.30-34
- 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.
- Гостищев Р.В., Соболева Г.Н., Самко А.Н., Осиев А.Г. Фармакологическое прекондиционирование. В фокусе - никорандил. Рос. кардиол. журн. 2017; (8): 114-21. doi: 10.15829/1560-4071-2017-8-114-121
- Ishii H, Ichimiya S, Kanashiro M et al. Impact of a single intravenous administration of nicorandil before reperfusion in patients with ST-segment-elevation myocardial infarction. Circulation 2005; 112 (9): 1284-8.
- Ono H, Osanai T, Ishizaka H et al. Nicorandil improves cardiac function and clinical outcome in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: role of inhibitory effect on reactive oxygen species formation. Am Heart J 2004; 148 (4): E15.
- Ota S, Nishikawa H, Takeuchi M et al. Impact of Nicorandil to Prevent Reperfusion Injury in Patients With Acute Myocardial Infarction Sigmart Multicenter Angioplasty Revascularization Trial (SMART). Circ J 2006; 70: 1099-104.
- 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.
- Kasama S, Toyama T, Sumino H et al. Long-term nicorandil therapy improves cardiac sympathetic nerve activity after reperfusion therapy in patients with first acute myocardial infarction. J Nucl Med 2007; 48: 1676-82.
- 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
- 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.
- 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
- Isono T, Kamihata H, Sutani Y et al. Nicorandil suppressed myocardial injury after percutaneous coronary intervention. Int J Cardiol 2008; 123 (2): 123-8.
- Hirohata A, Yamamoto K, Hirose E et al. Nicorandil prevents microvascular dysfunction resulting from PCI in patients with stable angina pectoris: a randomised study. Eur Int 2014; 9 (9): 1050-6. doi: 10.4244/EIJV9I9A178
- Nallamothu B.K, Chetcuti S, Mukherjee D et al. Prognostic implication of troponin I elevation after percutaneous coronary intervention. Am J Cardiol 2003; 91: 1272-74.
- Kini A.S, Lee P, Marmur J.D et al. Correlation of postpercutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality. Am J Cardiol 2004; 93: 18-23.
- Cavallini C, Savonitto S, Violini R et al. Impact of the elevation of biochemical markers of myocardial damage on long-103term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study. Eur Heart J 2005; 26: 1494-8.
- Thygesen K, Alpert J, Jaffe A et al. Third universal definition of myocardial infarction. Eur Heart J 2012; 33: 2551-67.
- Миронова О.Ю. Клиническое и прогностическое значение инфаркта миокарда, развившегося в результате проведения плановой коронарной ангиопластики у пациентов со стабильной ишемической болезнью сердца. Дис. … канд. мед. наук. М., 2015.
- Su Q, Li L, Zhao J et al. Effects of nicorandil on PI3K/Akt signaling pathway and its anti-apoptotic mechanisms in coronary microembolization in rats. Oncotarget 2017; 8: 99347-58.
