Nicorandil reduces the incidence of minor cardiac marker elevation after coronary stenting

Background: Minor cardiac marker elevation after percutaneous coronary intervention has long-term prognostic significance. We examined whether nicorandil, a nicotinamide-nitrate ester, reduces the incidence of minor cardiac marker elevation after coronary stenting. Methods: Patients (n = 192) undergoing coronary stenting were randomly assigned to receive nicorandil (nicorandil group, n = 91) or vehicle (control group, n = 101). Nicorandil (2 μg/kg/min, intravenously) was administered immediately after the patients were transferred into the catheterization laboratory and continued for 6 h. We measured the serum concentrations of creatine kinase isoenzyme MB (CK-MB) before, immediately after, and 6, 12, and 24 h after the procedure, and those of cardiac troponin T (cTnT) 24 h after the procedure. Results: There was no significant difference in clinical background between the 2 groups. The nicorandil group showed a significantly lower incidence of CK-MB elevation (> 1 × upper limit of control range, 20 IU/l) than the control group (8.8% vs 21.8%, p < 0.05). The levels of serum CK-MB in the nicorandil group were significantly lower than those in the control group (13.4 ± 5.7 vs 16.5 ± 9.7 IU/l, p < 0.01). Similarly, the nicorandil group showed a significantly lower incidence of cTnT elevation [> 1 × (0.1 ng/ml) or > 2 × (0.2 ng/ml)] upper limit of control range than the control group (14.3% vs 26.7%, p < 0.05, or 7.7% vs 17.8%, p < 0.05). Serum cTnT levels were also significantly lower in the nicorandil group than in the control group (0.05 ± 0.10 vs 0.15 ± 0.36 ng/ml, p < 0.05). Conclusions: The results demonstrated that nicorandil reduces minor cardiac marker elevation after coronary stenting.