Protective effect of nicorandil on myocardial injury following percutaneous coronary intervention in older patients with stable coronary artery disease: Secondary analysis of a randomized, controlled trial (RINC)

on behalf of the RINC investigators

Research output: Contribution to journalArticle

Abstract

Background Our previous study examined an effect of remote ischemic preconditioning (RIPC) or intravenous nicorandil on reduction of periprocedural myocardial injury (pMI) following percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD). We further investigated the effect of RIPC or nicorandil on pMI in older patients. Methods Patients with stable CAD who planned to undergo PCI were assigned to a 1:1:1 ratio to control, intravenous nicorandil, or upper-limb RIPC groups. This substudy analyzed patients aged >65 years (n = 282) from the principal cohort. The primary outcome was the incidence of pMI following PCI. We defined pMI as an elevated level of high-sensitive cardiac troponin T or creatine kinase myocardial band 12 or 24 hours after PCI. Results We found that pMI following PCI was significantly reduced in the nicorandil group compared with the control group (37.2% vs. 53.7%, multiplicity-adjusted p = 0.046), but not in the RIPC group compared with the control group (43.0% vs. 53.7%, multiplicity-adjusted p = 0.245). The adjusted odds ratios (95% confidence interval) for pMI in the RIPC and nicorandil groups versus the control group were 0.63 (0.34 to 1.16) and 0.51 (0.27 to 0.96), respectively. Conclusion Intravenous nicorandil significantly reduces pMI following PCI in a subgroup of older patients with stable CAD. Phase 3 trials are required to validate our results.

Original languageEnglish
Article numbere0194623
JournalPLoS One
Volume13
Issue number4
DOIs
Publication statusPublished - Apr 1 2018

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Nicorandil
Percutaneous Coronary Intervention
Ischemic Preconditioning
protective effect
Coronary Artery Disease
Randomized Controlled Trials
Wounds and Injuries
troponin T
Control Groups
creatine kinase
MB Form Creatine Kinase
Troponin T
odds ratio
confidence interval
coronary artery disease
Upper Extremity
incidence
Odds Ratio
Confidence Intervals
Incidence

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

@article{20afcb8144fa47d9ba3108c5e531e605,
title = "Protective effect of nicorandil on myocardial injury following percutaneous coronary intervention in older patients with stable coronary artery disease: Secondary analysis of a randomized, controlled trial (RINC)",
abstract = "Background Our previous study examined an effect of remote ischemic preconditioning (RIPC) or intravenous nicorandil on reduction of periprocedural myocardial injury (pMI) following percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD). We further investigated the effect of RIPC or nicorandil on pMI in older patients. Methods Patients with stable CAD who planned to undergo PCI were assigned to a 1:1:1 ratio to control, intravenous nicorandil, or upper-limb RIPC groups. This substudy analyzed patients aged >65 years (n = 282) from the principal cohort. The primary outcome was the incidence of pMI following PCI. We defined pMI as an elevated level of high-sensitive cardiac troponin T or creatine kinase myocardial band 12 or 24 hours after PCI. Results We found that pMI following PCI was significantly reduced in the nicorandil group compared with the control group (37.2{\%} vs. 53.7{\%}, multiplicity-adjusted p = 0.046), but not in the RIPC group compared with the control group (43.0{\%} vs. 53.7{\%}, multiplicity-adjusted p = 0.245). The adjusted odds ratios (95{\%} confidence interval) for pMI in the RIPC and nicorandil groups versus the control group were 0.63 (0.34 to 1.16) and 0.51 (0.27 to 0.96), respectively. Conclusion Intravenous nicorandil significantly reduces pMI following PCI in a subgroup of older patients with stable CAD. Phase 3 trials are required to validate our results.",
author = "{on behalf of the RINC investigators} and Norifumi Kawakita and Kentaro Ejiri and Toru Miyoshi and Kunihisa Kohno and Makoto Nakahama and Masayuki Doi and Mitsuru Munemasa and Masaaki Murakami and Kazufumi Nakamura and Hiroshi Itoh",
year = "2018",
month = "4",
day = "1",
doi = "10.1371/journal.pone.0194623",
language = "English",
volume = "13",
journal = "PLoS One",
issn = "1932-6203",
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TY - JOUR

T1 - Protective effect of nicorandil on myocardial injury following percutaneous coronary intervention in older patients with stable coronary artery disease

T2 - Secondary analysis of a randomized, controlled trial (RINC)

AU - on behalf of the RINC investigators

AU - Kawakita, Norifumi

AU - Ejiri, Kentaro

AU - Miyoshi, Toru

AU - Kohno, Kunihisa

AU - Nakahama, Makoto

AU - Doi, Masayuki

AU - Munemasa, Mitsuru

AU - Murakami, Masaaki

AU - Nakamura, Kazufumi

AU - Itoh, Hiroshi

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background Our previous study examined an effect of remote ischemic preconditioning (RIPC) or intravenous nicorandil on reduction of periprocedural myocardial injury (pMI) following percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD). We further investigated the effect of RIPC or nicorandil on pMI in older patients. Methods Patients with stable CAD who planned to undergo PCI were assigned to a 1:1:1 ratio to control, intravenous nicorandil, or upper-limb RIPC groups. This substudy analyzed patients aged >65 years (n = 282) from the principal cohort. The primary outcome was the incidence of pMI following PCI. We defined pMI as an elevated level of high-sensitive cardiac troponin T or creatine kinase myocardial band 12 or 24 hours after PCI. Results We found that pMI following PCI was significantly reduced in the nicorandil group compared with the control group (37.2% vs. 53.7%, multiplicity-adjusted p = 0.046), but not in the RIPC group compared with the control group (43.0% vs. 53.7%, multiplicity-adjusted p = 0.245). The adjusted odds ratios (95% confidence interval) for pMI in the RIPC and nicorandil groups versus the control group were 0.63 (0.34 to 1.16) and 0.51 (0.27 to 0.96), respectively. Conclusion Intravenous nicorandil significantly reduces pMI following PCI in a subgroup of older patients with stable CAD. Phase 3 trials are required to validate our results.

AB - Background Our previous study examined an effect of remote ischemic preconditioning (RIPC) or intravenous nicorandil on reduction of periprocedural myocardial injury (pMI) following percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD). We further investigated the effect of RIPC or nicorandil on pMI in older patients. Methods Patients with stable CAD who planned to undergo PCI were assigned to a 1:1:1 ratio to control, intravenous nicorandil, or upper-limb RIPC groups. This substudy analyzed patients aged >65 years (n = 282) from the principal cohort. The primary outcome was the incidence of pMI following PCI. We defined pMI as an elevated level of high-sensitive cardiac troponin T or creatine kinase myocardial band 12 or 24 hours after PCI. Results We found that pMI following PCI was significantly reduced in the nicorandil group compared with the control group (37.2% vs. 53.7%, multiplicity-adjusted p = 0.046), but not in the RIPC group compared with the control group (43.0% vs. 53.7%, multiplicity-adjusted p = 0.245). The adjusted odds ratios (95% confidence interval) for pMI in the RIPC and nicorandil groups versus the control group were 0.63 (0.34 to 1.16) and 0.51 (0.27 to 0.96), respectively. Conclusion Intravenous nicorandil significantly reduces pMI following PCI in a subgroup of older patients with stable CAD. Phase 3 trials are required to validate our results.

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VL - 13

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 4

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