The effect of nicorandil compared to placebo on cardiac outcomes of patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention: a meta-analysis

Introduction:
Nicorandil (2-nicotinamidoethyl-nitrate ester) is an ATP-sensitive potassium channel opener with the ability to donate nitric oxide (NO), which can increase coronary blood flow, particularly at the microcirculation level. Recent clinical trials have reported that nicorandil treatment during percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients can modulate their clinical outcomes; however, its effects on STEMI patients vary widely across different studies and patient subgroups.

Methods:
PubMed, Web of Science, Scopus, and Cochrane Library were systematically searched from inception to October 6, 2024. Due to significant heterogeneity, a random-effects model was adopted to pool data.

Results:
In this study, a total of 1802 participants in the control group and 1844 participants in the nicorandil group were included. Nicorandil treatment during PCI significantly decreased arrhythmia (RR = 0.52, 95% CI [0.32, 0.84], I² = 23.98%), and the re-hospitalization of patients (RR = 0.56, 95% CI [0.33, 0.95], I² = 0.00%); amelioration of the coronary blood flow level (RR = 1.07, 95% CI [1.01, 1.12], I² = 40.90%) was observed as well. Other clinical outcomes such as chest pain, cardiovascular death, and heart failure showed no significant effect of nicorandil treatment during the PCI procedure.

Conclusions:
Intracoronary nicorandil treatment during PCI in STEMI patients can significantly impact several important clinical outcomes, such as arrhythmia, coronary blood flow rate, and re-hospitalization incidence, but does not show significant effects on chest pain, cardiovascular death, and heart failure.