From September 2004 to October 2005, 29 patients underwent a primary
percutaneous coronary intervention and stenting with nicor-andil as a protocol
drug at a dose of 1 mg/hour - this
drug was titrated upwards to maximum tolerated dose, with a 2 mg intracoronary bolus given after balloon inflation during PCI. LAD was the
infarct related artery in 62% of cases. 72.4% of them had a TIMI
thrombus grade of 5. The corrected TIMI frame count following primary percutaneous intervention in the
Nicorandil arm was 19.54 + 8.7. None of the patients had a no flow or slow reflow phenomenon with this protocol. One patient developed a subacute
stent thrombosis necessitating a revascularization. At a mean follow up of 251 +/- 96.7% days,
MACE was not reported in the other patients. Thirty four patients underwent a primary
percutaneous coronary intervention and stenting without
nicorandil as an adjuvant
drug. Some of these patients were retrospectively assessed. They have been followed up for 285.4 +/- 264.6 days. LAD was the
infarct related artery in 61.8% of cases while 79.5% of them had a TIMI
thrombus grade of 5. The corrected TIMI frame count in this group was 23.9 +/- 17.5 (p <0.56).
MACE was reported in 5 of these patients. The mean TIMI frame count for these 5 patients was 40.5 +/- 29.2.
Glycoprotein IIb/IIIa receptor inhibitors were given to all patients in both groups. The choice of the agent used was left to the discretion of the operator.
CONCLUSION:
Nicorandil prevents no-flow/slow reflow phenomenon in patients undergoing primary PCI for acute
myocardial infarction. This is shown by a lower corrected TIMI frame count in the
nicorandil arm (p < 0.56). Reduction in the incidence of no-flow/slow reflow phenomenon translates into a lower
MACE. The
drug is safe and does not require intensive monitoring. It must be started early and electively in patients undergoing a primary PCI as a strategy to prevent no-flow rather than to treat this phenomenon.