Impact of intracoronary nicorandil before stent deployment in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

The present study aimed to clarify the effect of bolus intracoronary nicorandil on inflammatory, oxidative and adherent indicators in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This randomized controlled trial (RCT) was performed to detect the inflammation and oxidative stress in intracoronary blood both before and after PCI. In total, 65 consecutive patients undergoing PCI were classified into a nicorandil therapy group (n=32) or a placebo group (n=33). All procedures were performed at Shandong University Qilu Hospital, China, during the period from March, 2016 to May, 2017. Intracoronary blood from patients who received nicorandil therapy during PCI showed no change in soluble CD40 ligand (sCD40L) concentration (1.86 +/- 0.08 vs. 1.90 +/- 0.09 ng/ml, P=0.12) but a significant increase was noted in the control group (1.87 +/- 0.17 vs. 2.82 +/- 0.26 ng/ml, P<0.01). This indicated a relative reduction in sCD40L level after PCI in the nicorandil group. We further demonstrated an increase in superoxide dismutase (SOD) activity (29.37 +/- 0.81 vs. 31.03 +/- 0.60 U/ml, P<0.001) and a reduction in lipid peroxidation (3.84 +/- 0.99 vs. 4.23 +/- 0.13 U/ml, P=0.001) in the nicorandil group but observed no change in the placebo group. ICAM-1 levels showed no change in the nicorandil group (69.54 +/- 6.89 vs. 72.01 +/- 8.25 ng/ml, P=0.83) but a significant increase in the control group after PCI in intracoronary blood (56.57 +/- 4.96 vs. 76.81 +/- 6.88 ng/ml, P=0.002). No changes were found in hs-CRP, TNF alpha and sVCAM-1 levels in coronary blood for both groups before and after PCI in ACS patients. Our findings demonstrate that intracoronary bolus nicorandil therapy has a significant effect on the inhibition of inflammatory indicators and oxidative stress in patients with ACS during PCI. This suggests a possible medical application of nicorandil for reducing inflammation and oxidative stress.