Korean Circ J.  2004 Mar;34(3):258-264. 10.4070/kcj.2004.34.3.258.

The Clinical Effect of Intracoronary Adenosine and Nicorandil on No-reflow in Acute Myocardial Infarction during Percutaneous Coronary Intervention

• Lim SY
• Bae EH
• Jeong MH
• Kim HG
• Lim JH
• Park HW
• Hong YJ
• Park OY
• Kim JH
• Kim W
• Ahn YK
• Cho JG
• Park JC
• Kang JC

• KMID: 2227211
• DOI: http://doi.org/10.4070/kcj.2004.34.3.258

Abstract

BACKGROUND AND OBJECTIVES
This study aimed to clarify the role of combined intracoronary administration of adenosine and nicorandil in the no-reflow phenomenon.
SUBJECTS AND METHODS
Thirty four patients (66+/-10 years, 19 male) who developed no-reflow phenomenon during percutaneous coronary intervention (PCI) between January 2000 and December 2002 were examined as the subjects of the study. We classified the subjects into two groups:group I (20 patients, 67+/-10 years, 10 male, nitrate alone) and group II [14 patients, 69+/-11 years, 9 male, combined intra-coronary administration of adenosine (24 microgram/mL), nicorandil (2 mg/mL), and nitrate]. In-hospital and 6-month major adverse cardiac events (MACE) after PCI were compared between the two groups.
RESULTS
Mean age, sex, and risk factors were similar in both groups. Left ventricular ejection fraction was 49+/-7.4% in group I and 49+/-13.6% in group II (p=NS). The number of involved vessels, lesion type according to ACC/AHA classification, and TIMI flow rate were similar in both groups (p=NS). Incidence of dissection after balloon angioplasty, diameter and length of stent, and use of Reopro(r) did not differ during PCI. TIMI 3 flow was obtained in 10 (50%) out of 20 patients in group I and in 11 (78.6%) out of 14 patients in group II (p=0.033);blush score 3 was obtained in 8 (40%) patients in group I and in 10 (71.4%) patients in group II (p=0.01). In-hospital death did not occur in group II, but occurred in 4 patients in group I (p=0.041). MACE developed in an additional two patients in group I, and heart failure occurred in 6 (30%) and 3 (21.4%) patients in groups I and II, respectively, during a 6-month follow-up period (p=NS).
CONCLUSION
Intracoronary administration of ade-nosine with nicorandil improves no-reflow in patients with AMI during PCI and enhances the short-term clinical outcome.

Keyword

Coronary disease; Myocardial Infarction; Adenosine; Nicorandil

MeSH Terms

Adenosine*
Angioplasty, Balloon
Classification
Coronary Disease
Follow-Up Studies
Heart Failure
Humans
Incidence
Male
Myocardial Infarction*
Nicorandil*
No-Reflow Phenomenon
Percutaneous Coronary Intervention*
Risk Factors
Stents
Stroke Volume
Adenosine
Nicorandil