Evaluation of Cardioprotective Effect of a Single Oral Dose of Nicorandil before Primary PCI in Patients presenting with Anterior STEMI

Abstract

In patients presenting with STEMI, timely coronary reperfusion with thrombolysis and/or primary percutaneous coronary intervention has been long regarded as the gold standard for their management. Early reperfusion of totally occluded coronary arteries not only reduces the infarct size but also lowers the cardiac mortality rates, and the in-hospital events(133,134). However, some patients did not experience these benefits even when early reperfusion was achieved successfully, mostly due to reperfusion injury. Restoration of blood flow to severely ischemic yet viable cells may result in irreversible damage to the cardiomyocytes (4-6). The phenomenon of reperfusion injury represents a real challenge to modern medicine as it significantly reduce the beneficial effects of reperfusion and is believed to be responsible for nearly 50% of final infarct size genuinely deserving Braunwald's description from more than three decades ago as a double edged sword (4-6,12). However, the demonstration of the preconditioning and postconditioning phenomena clearly proved the concept that abrupt reperfusion has deleterious effects on both the endothelium and the myocardium and introduced the idea that modifying reperfusion conditions could alter the outcome of reperfusion with more myocardial salvage (9,10)