Effect of nicorandil administration on cardiac burden and cardio-ankle vascular index after coronary intervention

Shuji Sato,Kazuhiro Shimizu,Mahito Noro,Kohji Shirai,Masayo Kawazoe,Takuo Iizuka,Hiroshi Mikamo,Mao Takahashi

doi:10.1007/s00380-020-01650-9

Shuji Sato, Kazuhiro Shimizu + Show 6 more

Open Access

https://doi.org/10.1007/s00380-020-01650-9

Copy DOI

Abstract

Myocardial injury is a problem associated with percutaneous coronary intervention (PCI). This study aimed to clarify the role of nicorandil administration in preventing myocardial injury. This study included patients with stable angina who underwent PCI from November 2013 to June 2016. Of 58 consecutive patients, the first 20 patients received only saline infusion after PCI (control group); the other 38 patients received a continuous intravenous infusion of nicorandil and saline after PCI (nicorandil group). Troponin I and brain natriuretic peptide (BNP) levels were measured. Vascular parameters, such as blood pressure (BP), cardiac output, cardio-ankle vascular index (CAVI), and estimated systemic vascular resistance (eSVR), were measured. Troponin I of both groups increased 12 h after PCI. Changes in BNP levels between immediately after PCI and 12 h after PCI were significantly higher in the control than in the nicorandil group (10.8 ± 44.2 vs. − 2.6 ± 14.6 pg/ml, p = 0.04). In the nicorandil group, BP, eSVR, and CAVI decreased significantly at 12 h after PCI compared with those immediately after PCI (p < 0.0001), whereas no change was observed in the control group. In a single linear analysis, the change in BP (r = 0.36, p < 0.01) and nicorandil administration (r = − 0.47, p < 0.001) was significantly correlated with the change in CAVI, multiple regression analysis revealed that the changes in CO and eSVR were significant contributing factors for the changes in CAVI. PCI could result in myocardial injury and/or cardiac burden in patients with stable angina. Nicorandil administration after PCI may be effective in relieving the burden by decreasing arterial stiffness (CAVI).

Highlights

Percutaneous coronary intervention (PCI) for ischemic heart disease has made remarkable progress since it was first introduced in 1977 [1]
Twenty patients were assigned to the control group and 38 patients to the nicorandil group
Fluoroscopic time and contrast medium volume tended to be higher in the nicorandil group, no significant difference was observed

Summary

Introduction

Percutaneous coronary intervention (PCI) for ischemic heart disease has made remarkable progress since it was first introduced in 1977 [1]. Myocardial injury remains a problem in coronary intervention [9] When devices, such as a balloon catheter or stent, are inserted into the coronary artery lumen, and balloon dilation or stent expansion is performed, coronary plaques are sometimes crushed, and myocardial ischemia may occur with embolism due to the ruptured plaque fragments. Vessel injuries, such as coronary artery dissection and hematoma, may occur. Stent deployment for bifurcation lesion may result in side branch occlusion, which could be due to plaque shift or carina shift All these are problems associated with even advanced PCI techniques and often cause procedure-related myocardial injury, which in turn leads to cardiac dysfunction or heart failure.

Objectives

Methods

Results

Conclusion