Abstract: Objective To evaluate the effects of combined intracoronary and intravenous administration of nicorandil on myocardial microcirculation and short-term prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods A total of 100 patients with acute STEMI underwent PPCI were randomly divided into the nicorandil group (patients received intracoronary bolus injection of nicorandil when the target vessel opened and then continuous intravenous infusion within 24 hours, n=50) and the control group (patients received normal saline as control, n=50). The main outcome measures were immediate coronary flow and myocardial perfusion after PPCI, including thrombo-Lysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count (CTFC), reperfusion arrhythmia, ST-segment resolution, plasma creatine kinase isoenzyme (CK-MB) peak value and time. The secondary indicators were major adverse cardiovascular events (MACE) and left ventricular ejection fraction (LVEF) during hospitalization. Results There were no significant differences in hepatorenal function, heart rate and blood pressure before and after operation in each group (P＞0.05). The incidence of reperfusion arrhythmia, the level of MACE, CTFC, and peak value of CK-MB were all significantly lower in the nicorandil group compared with those of control group (P＜0.05). The proportions of patients with TIMI 3 flow, CK-MB peak time in 14 hours, and the proportion of ST-segment resolution were significantly higher in the nicorandil group than those of the control group (all P＜0.05). There was no significant difference in LVEF during hospitalization between two groups (P＞0.05). Conclusion Intracoronary and intravenous administration of nicorandil can significantly improve revascularization effects, reduce the occurrence of slow flow/no reflow, limit myocardial infarction size, increase myocardial perfusion and improve myocardial microcirculation and the short-term prognosis of acute STEMI patients.

Key words: nicorandil, myocardial infarction, angioplasty, transluminal, percutaneous coronary, myocardial reperfusion, prognosis, acute ST -segment elevation myocardial infarction