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European Heart Journal Advance Access originally published online on March 10, 2009
European Heart Journal 2009 30(7):765-772; doi:10.1093/eurheartj/ehp077
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon

Yusuke Kawai1,*, Kenichi Hisamatsu1, Hiromi Matsubara1, Kazuhiro Dan1, Satoshi Akagi1, Katsumasa Miyaji1, Mitsuru Munemasa1, Yoshihisa Fujimoto1, Kengo F. Kusano2 and Tohru Ohe2

1 Department of Cardiology, National Hospital Organization Okayama Medical Center, 1711-1, Tamasu, Okayama 701-1192, Japan
2 Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

Received 2 August 2008; revised 29 January 2009; accepted 5 February 2009; online publish-ahead-of-print 10 March 2009.

* Corresponding author. Tel: +81 86 294 9911, Fax: +81 84 294 9255, Email: jamkuhta{at}yahoo.co.jp

See page 750 for the editorial comment on this article (doi:10.1093/eurheartj/ehp065)

Aims: To determine the effect of intravenous administration of nicorandil on slow coronary flow (SCF) phenomenon in patients undergoing percutaneous coronary intervention (PCI).

Methods and results: In a preliminary study, 6 mg of nicorandil showed optimal efficacy for vasodilatation without causing significant haemodynamic instability. In the main study, a total of 408 patients were randomly assigned to receive intravenous administration of 6 mg of nicorandil immediately before PCI. The number of patients in the nicorandil group was 206 [acute coronary syndrome (ACS): 47, non-ACS: 159] and that in the control group was 202 (ACS: 61, non-ACS: 141). Nicorandil significantly decreased the incidence of post-procedural SCF phenomenon in both the ACS and non-ACS groups. The rate of target vessel revascularization (TVR) was significantly lower in the nicorandil group than in the control group in ACS patients.

Conclusion: Our simple procedure prevented SCF phenomenon not only in patients with ACS but also in patients with non-ACS without any adverse effect. Additionally our procedure reduced the rate of TVR in patients with ACS.

Key Words: Slow coronary flow phenomenon • Nicorandil • Percutaneous coronary intervention • Acute coronary syndrome


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