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IMPACT OF SINGLE INTRACORONARY NICORANDIL ADMINISTRATION ON MICROCIRCULATORY DISTURBANCE AFTER SUCCESSFUL PRIMARY PERCUTANEOUS INTERVENTION IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION
E989 JACC April 5, 2011 Volume 57, Issue 14
MYOCARDIAL ISCHEMIA AND INFARCTION IMPACT OF SINGLE INTRACORONARY NICORANDIL ADMINISTRATION ON MICROCIRCULATORY DISTURBANCE AFTER SUCCESSFUL PRIMARY PERCUTANEOUS INTERVENTION IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Sunday, April 03, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Acute Myocardial Infarction -- Pharmacological, Stem Cell and other Adjunctive Therapies Abstract Category: 3. Acute Myocardial Infarction—Therapy Session-Poster Board Number: 1037-316 Authors: Yasuji Doi, Noritoshi Ito, Shinsuke Nanto, Hirotaka Sawano, Tomoaki Natsukawa, Yuma Kurozumi, Daisuke Tonomura, Noriaki Yamada, Ken-ichiro Okada, Yasuyuki Hayashi, Tatsuro Kai, Toru Hayashi, Osaka Saiseikai Senri Hospital, Suita, Japan, Osaka University Graduate School of Medicine, Suita, Japan Background: Index of Microcirculatory Resistance (IMR) is an on-site parameter for the assessment of microcirculatory disturbance after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). High IMR has been shown to be a predictor of poor left ventricular (LV) function recovery. We sought to investigate the effects of intracoronary nicorandil administration after primary PCI on microvascular injury and chronic phase LV function. Methods: A total of 44 patients with first STEMI were studied. IMR in the infarct related artery was measured using PressureWire™ Certus (St. Jude Medical, USA) immediately after successful stenting of the culprit lesion (baseline) and after intracoronary nicorandil administration of 2 mg. LV ejection fraction (EF) was obtained just after successful primary PCI and at six months after. Results: Mean IMR of STEMI patients after successful primary PCI was very high (33U). Single intracoronary nicorandil administration significantly decreased the baseline IMR both in 14 patients with baseline-high IMR (>32U) and in the other 30 patients with baseline-low IMR (≤32U) (66±32U vs. 30±14U, p<0.01; 18±7 U vs. 14±5 U, p<0.01, respectively). The 14 baseline-high IMR patients were subdivided into two groups according to median IMR after nicorandil (29U). There was no difference in LVEF immediately after primary PCI among the patients with baseline-low IMR, those with baseline-high and after-nicorandil-low IMR and those with baseline-high and after-nicorandil-low IMR. As compared with LVEF at six months in the baseline-low IMR patients, it was maintained in 7 baseline-high and after-nicorandil-low IMR patients (61±9% vs. 62±10%, p=NS), but was significantly reduced in 7 patients with baseline-high and after-nicorandil-low IMR (51±9%, p<0.01). IMR levels after nicorandil correlated positively with peak creatinine kinase levels (r=0.39, p=0.01) and negatively with LVEF at 6 months (r=0.37, p=0.01). Conclusions: High IMR levels after primary PCI in patients with STEMI can be improved by intracoronary nicorandil administration, which may at least partly contribute to maintained LV function at 6 months.
MYOCARDIAL ISCHEMIA AND INFARCTION IMPACT OF SINGLE INTRACORONARY NICORANDIL ADMINISTRATION ON MICROCIRCULATORY DISTURBANCE AFTER SUCCESSFUL PRIMARY PERCUTANEOUS INTERVENTION IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Sunday, April 03, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Acute Myocardial Infarction -- Pharmacological, Stem Cell and other Adjunctive Therapies Abstract Category: 3. Acute Myocardial Infarction—Therapy Session-Poster Board Number: 1037-316 Authors: Yasuji Doi, Noritoshi Ito, Shinsuke Nanto, Hirotaka Sawano, Tomoaki Natsukawa, Yuma Kurozumi, Daisuke Tonomura, Noriaki Yamada, Ken-ichiro Okada, Yasuyuki Hayashi, Tatsuro Kai, Toru Hayashi, Osaka Saiseikai Senri Hospital, Suita, Japan, Osaka University Graduate School of Medicine, Suita, Japan Background: Index of Microcirculatory Resistance (IMR) is an on-site parameter for the assessment of microcirculatory disturbance after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). High IMR has been shown to be a predictor of poor left ventricular (LV) function recovery. We sought to investigate the effects of intracoronary nicorandil administration after primary PCI on microvascular injury and chronic phase LV function. Methods: A total of 44 patients with first STEMI were studied. IMR in the infarct related artery was measured using PressureWire™ Certus (St. Jude Medical, USA) immediately after successful stenting of the culprit lesion (baseline) and after intracoronary nicorandil administration of 2 mg. LV ejection fraction (EF) was obtained just after successful primary PCI and at six months after. Results: Mean IMR of STEMI patients after successful primary PCI was very high (33U). Single intracoronary nicorandil administration significantly decreased the baseline IMR both in 14 patients with baseline-high IMR (>32U) and in the other 30 patients with baseline-low IMR (≤32U) (66±32U vs. 30±14U, p<0.01; 18±7 U vs. 14±5 U, p<0.01, respectively). The 14 baseline-high IMR patients were subdivided into two groups according to median IMR after nicorandil (29U). There was no difference in LVEF immediately after primary PCI among the patients with baseline-low IMR, those with baseline-high and after-nicorandil-low IMR and those with baseline-high and after-nicorandil-low IMR. As compared with LVEF at six months in the baseline-low IMR patients, it was maintained in 7 baseline-high and after-nicorandil-low IMR patients (61±9% vs. 62±10%, p=NS), but was significantly reduced in 7 patients with baseline-high and after-nicorandil-low IMR (51±9%, p<0.01). IMR levels after nicorandil correlated positively with peak creatinine kinase levels (r=0.39, p=0.01) and negatively with LVEF at 6 months (r=0.37, p=0.01). Conclusions: High IMR levels after primary PCI in patients with STEMI can be improved by intracoronary nicorandil administration, which may at least partly contribute to maintained LV function at 6 months.