scholarly journals Clinical outcomes of nicorandil administration in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ning Geng ◽  
Li Ren ◽  
Lisheng Xu ◽  
Deling Zou ◽  
Wenyue Pang
Keyword(s):  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Major Adverse Cardiac Events ◽  
Controlled Trials ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
No Reflow Phenomenon

Abstract Background Primary percutaneous coronary intervention is the treatment of choice in ST-segment elevation myocardial infarction and no-reflow phenomenon is still an unsolved problem. Methods We searched PubMed, EmBase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. The primary endpoint was the incidence of major adverse cardiac events and the secondary endpoint was the incidences of no-reflow phenomenon and complete resolution of ST-segment elevation. Results Eighteen randomized controlled trials were enrolled. Nicorandil significantly reduced the incidence of no-reflow phenomenon (OR, 0.46; 95% CI, 0.36–0.59; P < 0.001; I2 = 0%) and major adverse cardiac events (OR, 0.42; 95% CI, 0.27–0.64; P < 0.001; I2 = 52%). For every single outcome of major adverse cardiac events, only heart failure and ventricular arrhythmia were significantly improved with no heterogeneity (OR, 0.36; 95% CI, 0.23–0.57, P < 0.001; OR, 0.43; 95% CI, 0.31–0.60, P < 0.001 respectively). A combination of intracoronary and intravenous nicorandil administration significantly reduced the incidence of major adverse cardiac events with no heterogeneity (OR, 0.24; 95% CI, 0.13–0.43, P < 0.001; I2 = 0%), while a single intravenous administration could not (OR, 0.66; 95% CI, 0.40–1.06, P = 0.09; I2 = 52%). Conclusions Nicorandil can significantly improve no-reflow phenomenon and major adverse cardiac events in patients undergoing primary percutaneous coronary intervention. The beneficial effects on major adverse cardiac events might be driven by the improvements of heart failure and ventricular arrhythmia. A combination of intracoronary and intravenous administration might be an optimal usage of nicorandil.

scholarly journals Clinical Outcomes of Nicorandil Administration In Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review And Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Ning Geng ◽  
Li Ren ◽  
Lisheng Xu ◽  
Deling Zou ◽  
Wenyue Pang
Keyword(s):  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Major Adverse Cardiac Events ◽  
Controlled Trials ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
No Reflow Phenomenon

Abstract Background: Primary percutaneous coronary intervention is the treatment of choice in ST-segment elevation myocardial infarction and no-reflow phenomenon is still an unsolved problem.Methods: We searched PubMed, EmBase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. The primary endpoint was the incidence of major adverse cardiac events and the secondary endpoint was the incidences of no-reflow phenomenon and complete resolution of ST-segment elevation. Results: Eighteen randomized controlled trials were enrolled. Nicorandil significantly reduced the incidence of no-reflow phenomenon (OR, 0.46; 95% CI, 0.36 to 0.59; P＜0.001; I2=0%) and major adverse cardiac events (OR, 0.42; 95% CI, 0.27 to 0.64; P＜0.001; I2=52%). For every single outcome of major adverse cardiac events, only heart failure and ventricular arrhythmia were significantly improved with no heterogeneity (OR, 0.36; 95% CI, 0.23 to 0.57, P＜0.001; OR, 0.43; 95% CI, 0.31 to 0.60, P＜0.001 respectively). A combination of intracoronary and intravenous nicorandil administration significantly reduced the incidence of major adverse cardiac events with no heterogeneity (OR, 0.24; 95% CI, 0.13 to 0.43, p＜0.001), while a single intravenous administration could not (OR, 0.66; 95% CI, 0.40 to 1.06, p=0.09; I2=52%). Conclusions: Nicorandil can significantly improve no-reflow phenomenon and major adverse cardiac events in patients undergoing primary percutaneous coronary intervention. The beneficial effects on major adverse cardiac events might be driven by the improvements of heart failure and ventricular arrhythmia. A combination of intracoronary and intravenous administration might be an optimal usage of nicorandil.

scholarly journals Circulating miR-660-5p is associated with the no-reflow phenomenon in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

2020 ◽  
Author(s):  
jian-wei zhang ◽  
Cheng-ping Hu ◽  
Ying-xin Zhao ◽  
Ling-jie He
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
No Reflow ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Abstract Background: The no-reflow phenomenon (NRP) is an important factor affecting the prognosis of patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). This study aims to investigate the association of circulating miR-660-5p with NRP in patients with ST segment elevation myocardial infarction (STEMI) undergoing PPCI.Methods: Consecutive patients diagnosed with anterior STEMI within 12 h of pain onset were included in the study; in these patients, coronary angiography confirmed that the infarct-related artery was the left anterior descending (LAD) artery. Angiographic NRP was defined as a final TIMI flow of 2 or a final TIMI flow of 3 with a myocardial blush grade (MBG) < 2. High miR-660-5p was defined as a value in the third tertile. The relationship of circulating miR-660-5p with NRP was assessed using Spearman correlation analysis and multiple logistic regression analysis.Results: Fifty-two eligible patients were finally included in this study (mean age: 56±12.4 years, >65 years: 53.8%, male: 76.9%, and mean BMI: 26.3±3.5). The incidence of NRP was 38.5%. Circulating miR-660-5p was significantly related to the mean platelet volume (MPV). Patients were divided into tertiles by miR-660-5p levels (Q1: ≤ 7.18, Q2: 7.18-11.31, Q3: > 11.31). Patients in the high microRNA-660-5p group had almost a 6-fold higher risk of NRP than those in the low microRNA-660-5p group [(odds ratio (OR)=5.68, 95% confidence interval (CI) 1.40-23.07, p=0.015). When analysed by tertiles, consistent trends of an increasing relative odds of NRP were reported (OR1 for Q2 VS. Q1: 1.25, 95% CI: 0.27-5.73, p=0.77; OR2 for Q3 VS. Q1: 5.96, 95% CI: 1.33-26.66, p=0.02), even after multivariable adjustment. Receiver operating characteristic curve analysis demonstrated that the microRNA-660-5p level of 10.17 was the best cut-off level to predict the incidence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention with an area under the curve (AUC) of 0.768 (95% CI: 0.636-0.890).Conclusion: Circulating miR-660-5p was significantly associated with NRP, and it may be a useful biomarker to predict the incidence of NRP in patients with STEMI undergoing PPCI.

scholarly journals Primary percutaneous coronary interventions in patients with ST-segment elevation myocardial infarction complicated by «no-reflow» phenomenon

2015 ◽  
Vol 96 (3) ◽  
pp. 325-329
Author(s):  
M M Iskhakov ◽  
R R Sayfullin ◽  
I R Yagafarov ◽  
M G Khatypov ◽  
N V Gazizov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Balloon Angioplasty ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Aim. To study the association of «no-reflow» phenomenon incidence and the method of primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction, and to determine the optimal tactics for primary coronary intervention.Methods. A retrospective analysis of 1339 cases of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction performed in the period from January 2008 to June 2013 was executed. Depending on surgery method, all the patients were allocated to four groups: first group - direct stenting (n=483); second group - thromboaspiration before stenting (n=142); third group - balloon angioplasty and stenting using a small-diameter balloon ≤2.0 mm (n=491); fourth group - balloon angioplasty and stenting using a small-diameter balloon and subsequent use of medium and large-diameter balloons ≥2.0 mm (n=223).Results. «No-reflow» phenomenon was observed in 164 (12.2%) of cases, incliding 34 (7.0%) cases in the first group, 12 (8.4%) cases in the second group, 53 (10.8%) cases in the third group, and with the majority of cases seen in the fourth group - 65 (29.1%). At primary percutaneous coronary intervention, the following incidence of «no-reflow» phenomenon was observed depending on the infarct-related artery: left anterior descending artery - 85 cases (51.82% of the total number), right coronary artery - 51 (31.09%) cases, circumflex artery - 28 (17.07%) cases, and diagonal branch - 1 (0.6%) case.Conclusion. In primary percutaneous coronary intervention with direct stenting and thromboaspiration before stenting, the incidence of «no-reflow» phenomenon is significantly lower. Patients who undergo primary percutaneous coronary intervention preceded by repeated balloon angioplasty using medium and large-diameter balloons are at higher risk for «no-reflow» phenomenon.

scholarly journals Utility of Hematological Parameters in Predicting No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

2018 ◽  
Vol 24 (7) ◽  
pp. 1177-1183 ◽  
Author(s):  
Zuoyan Wang ◽  
Lihui Ren ◽  
Na Liu ◽  
Jianjun Peng
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Hematological Parameters ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Lymphocyte Ratio ◽  
No Reflow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Objective: Because the no-reflow phenomenon in patients with ST- segment elevation myocardial infarction can lead to poor outcomes and early identification of patients at high risk may alter the clinical outcome, we aimed to study possible differences in the predictive utility among hematological parameters for early identification of patients at high risk of the no-reflow phenomenon during the primary percutaneous coronary intervention. Methods: A total of 612 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were enrolled. The patients were divided into 2 groups: no-reflow and normal reflow. Hematological parameters were measured on admission. Sensitivity, specificity, positive and negative predictive values, and receiver–operating characteristic areas under the curve were determined to evaluate the predictive values of these parameters. Results: The patients in the no-reflow group had a significantly higher neutrophil count, neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, and mean platelet volume-to-lymphocyte ratio when compared to the normal reflow patients. We identified mean platelet volume-to-lymphocyte ratio to have a moderate predictive value and high specificity (66.8%) for the no-reflow phenomenon. Neutrophil–lymphocyte ratio provided the largest area under the curve for predicting no reflow. Regarding the predictive utility for no reflow, the comparison showed no statically significant differences among evaluated hematological parameters. Conclusion: For the prediction of no reflow, mean platelet volume-to-lymphocyte ratio yielded moderate performance. No hematological parameter on admission had persuasive superior capacities to predict no-reflow in patients receiving the primary percutaneous coronary intervention.

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