Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction

J Am Coll Cardiol. 1999 Mar;33(3):654-60. doi: 10.1016/s0735-1097(98)00604-4.


Objectives: We assessed whether the intravenous administration of nicorandil, an adenosine triphosphate (ATP)-sensitive K+ channel opener, exerts beneficial effect on microvascular function and functional and clinical outcomes in patients with acute myocardial infarction (AMI).

Background: Experimental studies documented that ATP-sensitive K+ channel opener exerts cardioprotection after prolonged ischemia.

Methods: We randomly divided 81 patients with a first anterior AMI into two groups, nicorandil (n = 40) and control groups (n = 41). All patients received successful coronary angioplasty within 12 h after the symptom onset and underwent myocardial contrast echcardiography (MCE) with the intracoronary injection of sonicated microbubbles. In the nicorandil group, we injected 4 mg of nicorandil followed by the infusion at 6 mg/h for 24 h and by oral nicorandil (15 mg/day).

Results: The improvement in regional left ventricular function, wall motion score and regional wall motion was significantly better in the nicorandil group then in the control group. Intractable congestive heart failure, malignant ventricular arrhythmia and pericardial effusion were more frequently found in the control group than in the nicorandil group (15% vs. 37%, 5% vs. 20% and 8% vs. 37%, p < 0.05, respectively). The frequency of sizable MCE no reflow phenomenon was significantly lower in the nicorandil group than in the control group (15% vs. 33%, p < 0.05).

Conclusions: Intravenous nicorandil in conjunction with coronary angioplasty is associated with better functional and clinical outcomes compared to angioplasty alone in patients with an anterior AMI. Myocardial contrast echocardiography findings imply that an improvement in microvascular function with nicorandil may be attributable to this better outcome.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Angioplasty, Balloon, Coronary
  • Cardiac Catheterization
  • Coronary Angiography
  • Coronary Vessels / drug effects*
  • Coronary Vessels / physiopathology
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Ventricles / drug effects
  • Heart Ventricles / metabolism
  • Humans
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Myocardial Contraction / drug effects*
  • Myocardial Infarction / etiology
  • Myocardial Infarction / physiopathology*
  • Myocardial Infarction / surgery
  • Myocardial Reperfusion Injury / complications
  • Myocardial Reperfusion Injury / physiopathology*
  • Nicorandil / administration & dosage
  • Nicorandil / therapeutic use*
  • Potassium Channels / drug effects
  • Potassium Channels / metabolism
  • Prognosis
  • Radionuclide Ventriculography
  • Retrospective Studies
  • Sodium-Potassium-Exchanging ATPase / drug effects
  • Sodium-Potassium-Exchanging ATPase / metabolism
  • Vasodilator Agents / administration & dosage
  • Vasodilator Agents / therapeutic use*


  • Potassium Channels
  • Vasodilator Agents
  • Nicorandil
  • Sodium-Potassium-Exchanging ATPase