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

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 groupsgroup 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.