Effect of ticagrelor combined with nicorandil on endothelial function and coronary blood flow after PCI treatment in STEMI patients

This study investigated the effect of ticagrelor combined with nicorandil on endothelial function and coronary blood flow after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). We retrospectively analyzed 300 STEMI patients who underwent emergency PCI, 150 in the observation group and 150 in the control group. The control group was given oral ticagrelor. The observation group received oral nicorandil along with the control group. A significant improvement in peak ejection rate (PER) and left ventricular (LV) ejection fraction (EF) occurred after the operation, while LV end-diastolic volume index (LVESVI), LV end-diastolic internal diameter (LVEDD), cardiac troponin I (cTnI), and creatine kinase myoglobin (CK-MB) were significantly reduced compared to the preoperative period. Improvements in cardiac function were significantly greater in the observation group than in the control group (p < 0.05). After the operation, both groups’ serum nitric oxide (NO) and endothelin-1 (ET-1) levels were greatly higher and lower, respectively, during the preoperative period (p < 0.05). The observation group’s serum NO level was significantly higher than the control group’s, and its ET-1 level was substantially lower than the control group’s (p < 0.05). There was a significant increase in thrombolysis in myocardial infarction (TIMI) flow grade 3 percentage and TIMI myocardial perfusion grade (TMPG) grade 3 percentage in the observation group in the immediate postoperative period compared to the control group, despite a significantly lower corrected TIMI Frame count (CTFC) (p < 0.05). 1 month postoperatively, major adverse cardiovascular events (MACE) incidence was significantly lower in the observation group than in the control group (χ2 = 3.914, p = 0.048). The preoperative combination of ticagrelor and nicorandil in STEMI patients undergoing PCI helped attenuate vascular endothelial function impairment, improved coronary blood flow, and promoted postoperative cardiac function recovery.

STEMI; PCI; Ticagrelor; Nicorandil

[1] Xue T, Zhang H, Wu J, Li C. Effect of pre-percutaneous coronary intervention ticagrelor administration on coronary reperfusion and short-term prognosis in patients with acute myocardial infarction. Tropical Journal of Pharmaceutical Research. 2023; 22: 1327–1333.

[2] Frampton J, Ortengren AR, Zeitler EP. Arrhythmias after acute myocardial infarction. The Yale Journal of Biology and Medicine. 2023; 96: 83–94.

[3] Bhatt DL, Lopes RD, Harrington RA. Diagnosis and treatment of acute coronary syndromes: a review. JAMA. 2022; 327: 662–675.

[4] Sheldon M, Blankenship JC. STEMI in nonagenarians: never too old. Catheterization and Cardiovascular Interventions. 2022; 100: 17–18.

[5] Fabris E, Selvarajah A, Tavenier A, Hermanides R, Kedhi E, Sinagra G, et al. Complementary pharmacotherapy for STEMI undergoing primary PCI: an evidence-based clinical approach. American Journal of Cardiovascular Drugs. 2022; 22: 463–474.

[6] Konijnenberg LSF, Damman P, Duncker DJ, Kloner RA, Nijveldt R, van Geuns RM, et al. Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Cardiovascular Research. 2020; 116: 787–805.

[7] Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022; 145: e4–e17.

[8] World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Bulletin of the World Health Organization. 2001; 79: 373–374.

[9] Heiberg E, Sjögren J, Ugander M, Carlsson M, Engblom H, Arheden H. Design and validation of segment—freely available software for cardiovascular image analysis. BMC Medical Imaging. 2010; 10: 1.

[10] Stephensen S, Steding-Ehrenborg K, Munkhammar P, Heiberg E, Arheden H, Carlsson M. The relationship between longitudinal, lateral, and septal contribution to stroke volume in patients with pulmonary regurgitation and healthy volunteers. American Journal of Physiology Heart and Circulatory Physiology. 2014; 306: H895–H903.

[11] Pahlm U, Ostenfeld E, Seemann F, Engblom H, Erlinge D, Heiberg E, et al. Evolution of left ventricular function among subjects with ST-elevation myocardial infarction after percutaneous coronary intervention. BMC Cardiovascular Disorders. 2020; 20: 309.

[12] Qian G, Zhang Y, Dong W, Jiang ZC, Li T, Cheng LQ, et al. Effects of nicorandil administration on infarct size in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the CHANGE trial. Journal of the American Heart Association. 2022; 11: e026232.

[13] Mehran R, Baber U, Sharma SK, Cohen DJ, Angiolillo DJ, Briguori C, et al. Ticagrelor with or without aspirin in high-risk patients after PCI. The New England Journal of Medicine. 2019; 381: 2032–2042.

[14] Ahmed LA. Nicorandil: a drug with ongoing benefits and different mechanisms in various diseased conditions. Indian Journal of Pharmacology. 2019; 51: 296–301.

[15] Pereira NL, Rihal CS, So DYF, Rosenberg Y, Lennon RJ, Mathew V, et al. Clopidogrel pharmacogenetics. Circulation Cardiovascular Interventions. 2019; 12: e007811.

[16] Patti G, Micieli G, Cimminiello C, Bolognese L. The role of clopidogrel in 2020: a reappraisal. Cardiovascular Therapeutics. 2020; 2020: 8703627.

[17] Horikoshi T, Nakamura T, Yoshizaki T, Watanabe Y, Uematsu M, Kobayashi T, et al. Impact of persistent endothelial dysfunction in an infarct-related coronary artery on future major adverse cardiovascular event occurrence in STEMI survivors. Heart and Vessels. 2021; 36: 472–482.

[18] Strassheim D, Verin A, Batori R, Nijmeh H, Burns N, Kovacs-Kasa A, et al. P2Y purinergic receptors, endothelial dysfunction, and cardiovascular diseases. International Journal of Molecular Sciences. 2020; 21: 6855.

[19] Kelly JJ, Whitworth JA. Whitworth, Endothelin-1 as a mediator in cardiovascular disease. Clinical and Experimental Pharmacology & Physiology. 1999; 26: 158–161.

[20] Davis MG, Blankenship JC. PCI for late STEMI: better late than never? Catheterization and Cardiovascular Interventions. 2023; 101: 11–12.

[21] Bikdeli B, Erlinge D, Valgimigli M, Kastrati A, Han Y, Steg PG, et al. Bivalirudin versus heparin during PCI in NSTEMI: individual patient data meta-analysis of large randomized trials. Circulation. 2023; 148: 1207–1219.