Objective To evaluate the effectiveness of nicorandil for reperfusion of acute myocardial infarction (AMI), so as to provide high quality evidence for formulating the rational AMI therapy. Methods Databases including The Cochrane Library (Issue 3, 2012), PubMed, EMbase, HighWire, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) on nicorandil in AMI reperfusion published before March 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and evaluated the methodological quality of the included studies. Then the meta-analysis was conducted using RevMan5.1 software. Results A total of 11 trials involving 1 027 patients were included. The results of meta-analyses showed that: for AMI reperfusion, nicorandil could decrease the non-reflow or slow flow rate (RR=0.34, 95%CI 0.19 to 0.61, P=0.000 3), improve the left ventricular ejection fraction (MD=5.49, 95%CI 4.51 to 6.47, Plt;0.000 01), reduce the left ventricular end-diastolic volume (MD=–14.38, 95%CI –17.31 to –11.45, Plt;0.000 01), and decrease the incidence of cardiac adverse events (RR=0.34, 95%CI 0.25 to 0.46, Plt;0.000 01), readmission rate (RR=0.33, 95%CI 0.17 to 0.63, P=0.000 8) and mortality rate (RR=0.40, 95%CI 0.16 to 0.97, P=0.04). Conclusion Current evidence shows that nicorandil used as an adjuvant for AMI reperfusion can increase coronary microcirculation, improve prognosis, and decrease the incidence of cardiac adverse events, readmission and mortality rate. Due to the limited quality and quantity of the included studies, this conclusion still needs to be further proved by performing more large-scale and high quality RCTs, so we suggest clinician should adopt rational therapies based on patient’s conditions.
Objective To evaluate the clinical efficacy and safety of nicorandil injection for preventing slow-flow/ no-reflow phenomenon after coronary stent implantation. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2009), PubMed, MEDLINE, EMbase, CBM, CNKI, VIP, Wanfang database, etc. from their inception to April 2009. Some relevant journals were handsearched as well. Two reviewers independently evaluated the quality of included studies and extracted the data. Meta-analysis was performed by RevMan 5.0 software. Results Seven randomized controlled trials (RCTs) involving 630 patients were included. The results of meta-analyses showed that intracoronary and intravenous nicorandil could reduce the incidence of no-reflow/ low-flow, reduce Corrected TIMI Frame Count (CTFC), and improve left ventricular ejection fraction (LVEF). Intravenous nicorandil could reduce the incidence of ventricular tachycardia/ventricular fibrillation (VT/VF), pericardial effusion, heart failure, but couldn’t reduce the incidence of death and recurrent myocardial infarction (MI) death. Conclusion Evidence shows that intracoronary nicorandil could prevent no-reflow/ slow-flow, reduce CTFC, improve LVEF, and reduce adverse reaction in patients after coronary stent implantation. However, there is a moderate possibility of selection bias, performance bias and publication bias in this review because of the small number of the included studies, which weakens the strength of the evidence of our results. More large sample size, high-quality RCTs are needed.