Abstract
Summary Nicorandil (SG-75; SG), 2-nicotinamidoethyl nitrate, is a new antianginal drag with coronary dilatory properties, according to investigations conducted in Japan. In nine patients with coronary artery disease and with reproducible pacing-induced myocardial ischemia, the effect of SG, 20 mg sublingually, was studied, i.e., changes in heart rate, arterial pressure, angiographic left ventricular (LV) ejection parameters, contractility, LV function, LV work, myocardial oxygen consumption, cardiac efficiency, and regional wall motion for the following hemodynamic phases were investigated at the 7th and 14th min after SG, the immediate postpacing phase without medication, and the postpacing phase under the influence of SG. There was no change as compared with control values (p > 0.05) in the 7th and 14th min after SG application and without stress. In the 15th and 16th min post-SG (serum level control), under equipotent pacing stress, myocardial ischemia could no longer be elicited, as, however, had been the case in the postpacing period without medication. In addition, percentile parameter changes (p < 0.05) comparing the postpacing phase, with SG, with the postpacing phase, without medication, were as follows: ejection fraction, +21%; cardiac index, +37%; stroke work index, +48%; LV work, +52%; cardiac efficiency, +60%; and regional wall motion, improved. “Protection from ischemia” and improved hemodynamics under SG influence were probably mainly due to a decrease in preload (left ventricular end-diastolic pressure, by −41%) and afterload (systemic vascular resistance, by −29%). These parameter changes correspond to alterations that could have been expected theoretically also after nitroglycerin given under similar conditions. Because, in addition, no untoward effects, either subjective or objective, could be elicited during or after application of SG, this seems to be a promising drug for antianginal therapy of the future.
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