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CLINICAL STUDY: MYOCARDIAL ISCHEMIA

Additive effects of nicorandil on coronary blood flow during continuous administration of nitroglycerin

Atsunori Okamura, MD^*, Hiromi Rakugi, MD^*, Mitsuru Ohishi, MD^*, Yoshihiro Yanagitani, MD^*, Masumi Shimizu, MD^*, Tadahiko Nishii, MD, Yoshiaki Taniyama, MD^*, Takashi Asai, MD^*, Shin Takiuchi, MD^*, Koichi Moriguchi, MD^*, Masashi Ohkuro, MD^*, Norio Komai, MD^*, Kazuo Yamada, MD, Nozomu Inamoto, MD^*, Atsuhiro Otsuka, MD, Jitsuo Higaki, MD^* and Toshio Ogihara, MD^*

^* Department of Geriatric Medicine, Osaka University Medical School, Suita, Osaka, Japan
Division of Cardiology, Ibaraki Iseikai Hospital, Ibaraki, Osaka, Japan

Manuscript received April 27, 2000; revised manuscript received September 28, 2000, accepted November 3, 2000.

Reprint requests and correspondence: Dr. Jitsuo Higaki, Department of Geriatric Medicine, Osaka University Medical School, Yamadaoka 2-2 B6, Suita 565-0871, Japan
higaki{at}geriat.med.osaka-u.ac.jp

OBJECTIVES

We examined whether patients with ischemic heart disease (IHD) should be treated with nicorandil, an adenosine triphosphate-sensitive potassium channel opener, in addition to the regular use of nitrates.

BACKGROUND

It has been reported that nicorandil possibly has additive effects on nitroglycerin (NTG) treatment for angina, but the mechanism is not clear.

METHODS

We directly measured anterograde coronary blood flow (CBF) with a Doppler guide wire to examine the effects of intravenous administration of NTG (0.3 mg) and nicorandil (6 mg) during continuous administration of NTG at a sufficient dose (25 µg/min) in subjects with normal and stenotic coronary arteries.

RESULTS

Additional systemic administration of NTG decreased anterograde CBF (normal –19.7%; stenotic –21.2%). In contrast, nicorandil increased anterograde CBF in both normal (54.6%) and stenotic (89.6%) coronary arteries, without the coronary steal phenomenon. There was a tendency toward nicorandil-dilated diameters in the patients with stenotic arteries (p = 0.06). There were no effects of additional administration on pulmonary artery wedge pressure. There was no difference in changes in heart rate and mean aortic blood pressure between NTG and nicorandil therapy.

CONCLUSIONS

These results suggest that in patients treated with nitrates, additional administration of nicorandil is more useful, in terms of increasing CBF, than additional administration of nitrates. Adjunctive use of nicorandil with nitrates may provide the further benefit of myocardial protection and may improve the prognosis of patients with IHD.

Abbreviations and Acronyms   APV = averaged peak (blood) velocity   ATP = adenosine triphosphate   CBF = coronary blood flow   CSA = cross-sectional area   IHD = ischemic heart disease   LAD = left anterior descending coronary artery   LCA = left coronary artery   LCx = left circumflex coronary artery   NTG = nitroglycerin   PTCA = percutaneous transluminal coronary angioplasty

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