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Abstract
BackgroundOur previous study examined an effect of remote ischemic preconditioning (RIPC) or intravenous nicorandil on reduction of periprocedural myocardial injury (pMI) following percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD). We further investigated the effect of RIPC or nicorandil on pMI in older patients.MethodsPatients with stable CAD who planned to undergo PCI were assigned to a 1:1:1 ratio to control, intravenous nicorandil, or upper-limb RIPC groups. This substudy analyzed patients aged >65 years (n = 282) from the principal cohort. The primary outcome was the incidence of pMI following PCI. We defined pMI as an elevated level of high-sensitive cardiac troponin T or creatine kinase myocardial band 12 or 24 hours after PCI.ResultsWe found that pMI following PCI was significantly reduced in the nicorandil group compared with the control group (37.2% vs. 53.7%, multiplicity-adjusted p = 0.046), but not in the RIPC group compared with the control group (43.0% vs. 53.7%, multiplicity-adjusted p = 0.245). The adjusted odds ratios (95% confidence interval) for pMI in the RIPC and nicorandil groups versus the control group were 0.63 (0.34 to 1.16) and 0.51 (0.27 to 0.96), respectively.ConclusionIntravenous nicorandil significantly reduces pMI following PCI in a subgroup of older patients with stable CAD. Phase 3 trials are required to validate our results.Trial registrationUMIN Clinical Trials Registry UMIN000005607.
Highlights
Periprocedural myocardial injury is a complication of elective percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) and affects long-term prognosis [1,2]
We found that periprocedural myocardial injury (pMI) following PCI was significantly reduced in the nicorandil group compared with the control group (37.2% vs. 53.7%, multiplicity-adjusted p = 0.046), but not in the remote ischemic preconditioning (RIPC) group compared with the control group (43.0% vs. 53.7%, multiplicity-adjusted p = 0.245)
In this post-hoc analysis of a multicenter, randomized controlled trial, we demonstrated that intravenous nicorandil significantly reduced the incidence of pMI following PCI in older patients with stable CAD compared with the control group
Summary
Periprocedural myocardial injury (pMI) is a complication of elective percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) and affects long-term prognosis [1,2]. The potential contributing mechanisms for pMI following elective PCI in patients with stable angina include downstream embolization of atheromatous material and coronary side-branch occlusion [3,4]. Several approaches, including remote ischemic preconditioning (RIPC) and nicorandil, have been evaluated to increase cardiac tolerance to ischemic injury following PCI [11,12,13,14,15,16,17,18,19]. Our previous study examined an effect of remote ischemic preconditioning (RIPC) or intravenous nicorandil on reduction of periprocedural myocardial injury (pMI) following percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD). We further investigated the effect of RIPC or nicorandil on pMI in older patients.
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