The effect of nicorandil in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and meta-analysis.

OBJECTIVE : To study the effect of nicorandil on prognosis of patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).
METHODS : We retrieved literatures from Web of Science, Pubmed, Embase, and Cochrane Library. The retrieval time was limited from inception to December 2018.
RESULTS : Nineteen randomized controlled trials involving 2176 patients were finally selected for this study. Meta-analysis showed that nicorandil can significantly reduce corrected TIMI frame count (cTFC) (WMD = - 5.27; 95% CI (- 6.61, - 3.93); P < 0.00001) and improve the no-reflow or slow-reflow phenomenon of coronary arteries (thrombolysis in myocardial infarction (TIMI) ≤ 2) (RR = 0.52; 95% CI (0.40, 0.68); P < 0.001). Compared with control group, nicorandil group has higher left ventricular ejection fraction (LVEF) (WMD = 3.42; 95% CI (1.32, 5.51); P = 0.001), and subgroup analysis showed that sex ratio was one source of heterogeneity (male/female ratio < 4 for low M/F group, M/F > 4 for high M/F group). In the low M/F group, LVEF in nicorandil group was increased significantly (WMD = 4.61; 95% CI (3.03, 6.20); P < 0.001), while there was no significant difference in LVEF between two groups in the high M/F group (WMD = 1.00; 95% CI (- 1.09, 3.09); P = 0.350). In addition, the incidence of in-hospital reperfusion arrhythmia (RR = 0.47; 95% CI (0.36, 0.63); P < 0.00001) and major adverse cardiovascular events (MACEs) (RR = 0.49; 95% CI (0.35, 0.69); P < 0.001) were significantly lower in the nicorandil group than that in control group.
CONCLUSIONS : Nicorandil can improve coronary microcirculation and left ventricular function of patients with AMI after PCI. Interestingly, female patients may benefit more from nicorandil than male patients in improving heart function.