Background

The amelioration of myocardial reperfusion in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI) remains a significant issue.

Objective

We conducted a meta-analysis of randomized controlled trials (RCTs) to better assess the effects of intracoronary nicorandil administration on myocardial microcirculation and clinical outcomes in these patients.

Methods

The meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A literature search was performed in the PubMed, Embase, Cochrane Library, and Web of Science databases up to April 2019, with no time or language limitations. Pooled risk ratios (RRs) were calculated to evaluate the treatment effects.

Results

Seven RCTs involving a total of 562 patients were included. Compared with control, intracoronary nicorandil significantly reduced the incidence of thrombolysis in myocardial infarction (TIMI) grade ≤ 2 (RR 0.349; 95% confidence interval [CI] 0.199–0.611; P < 0.001) and TIMI myocardial perfusion grade ≤ 2 (RR 0.611; 95% CI 0.438–0.852; P = 0.004) and was associated with higher complete ST-segment resolution rates (RR 1.326; 95% CI 1.090–1.614; P = 0.005). However, no significant benefits were observed on clinical outcomes, including death (RR 0.370; 95% CI 0.085–1.618; P = 0.187), recurrent myocardial infarction (RR 0.507; 95% CI 0.156–1.655; P = 0.261), heart failure (RR 0.528; 95% CI 0.224–1.247; P = 0.145), and target lesion/vessel revascularization (RR 1.109; 95% CI 0.553–2.224; P = 0.770).

Conclusions

Intracoronary nicorandil can significantly improve myocardial microcirculation in patients with AMI undergoing PPCI, but it failed to offer clinically significant benefits.

中文翻译：

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冠状动脉内尼古兰地对急性心肌梗死患者心肌微循环和临床结果的影响：一项随机对照试验的荟萃分析。

背景

接受初次经皮冠状动脉介入治疗（PPCI）的急性心肌梗死（AMI）患者的心肌再灌注改善仍然是一个重要问题。

目的

我们进行了一项随机对照试验（RCT）的荟萃分析，以更好地评估这些患者中冠脉内尼可地尔给药对心肌微循环和临床结局的影响。

方法

荟萃分析是根据PRISMA（系统评价和荟萃分析的首选报告项目）声明进行的。截至2019年4月，在PubMed，Embase，Cochrane图书馆和Web of Science数据库中进行了文献检索，没有时间或语言限制。计算汇总风险比（RRs）以评估治疗效果。

结果

纳入了总共涉及562名患者的7个RCT。与对照组相比，冠脉内尼可地尔显着降低了心肌梗死（TIMI）≤2（RR 0.349； 95％置信区间[CI] 0.199-0.611；P  <0.001）和TIMI心肌灌注≤2（RR 0.611 ）的溶栓发生率； 95％CI 0.438–0.852；P  = 0.004），并与更高的完整ST段分辨率相关（RR 1.326； 95％CI 1.090–1.614；P  = 0.005）。但是，没有观察到对临床结局有明显益处，包括死亡（RR 0.370； 95％CI 0.085–1.618；P  = 0.187），复发性心肌梗死（RR 0.507； 95％CI 0.156-1.655；P  = 0.261），心力衰竭（RR 0.528； 95％CI 0.224-1.247；P  = 0.145）和目标病变/血管血运重建（RR 1.109； 95％CI 0.553–2.224；P  = 0.770）。

结论

冠脉内尼可地尔可以显着改善接受PPCI的AMI患者的心肌微循环，但未能提供临床上显着的益处。