الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The aim of reperfusion therapy in STEMI patients for many years has focused on achieving epicardial artery patency at the site of the occlusive thrombus. It is now possible, through advances in interventional techniques and adjunctive pharmacological treatment, to achieve TIMI (Thrombosis In Myocardial Infarction) grade 3 epicardial flow (normal) in most of patients.
Despite this achievement, mortality and morbidity, although declining, still remains high with 9% death and 10% heart failure at 1 year. This is mostly because of reperfusion injury, microvascular dysfunction and obstruction, which occur in almost half of STEMI patients after primary PCI, and are important causes of subsequent deterioration of cardiac function and poor prognosis in these patients. Therefore, it is hypothesized that early application of agents that attenuate coronary microvascular dysfunction and obstruction may further improve the prognosis of patients with STEMI despite effective revascularization.
Nicorandil, as a hybrid of an adenosine triphosphate (ATP)-sensitive opener of potassium channel and nitrates, has been demonstrated to improve coronary microvascular dysfunction and obstruction via its vasodilatory effect on small coronary arteries. In addition, Nicorandil may also exert cardio-protective effect via anti-oxidation, anti-inflammation and mimicking of ischemic preconditioning.
Our study is a prospective randomized controlled study that aimed at defining the the role of adding oral Nicorandil with primary PCI in infarct size reduction assessed by Tc99m SPECT one month after presentation in patients with acute STEMI.
The 60 eligible patients with acute STEMI managed with primary PCI, were randomized into two groups; Nicorandil group who received oral Nicorandil 10 mg at time of admission and continued oral 10 mg Nicorandil twice daily for 10 days after presentation and control group who didn’t receive oral Nicorandil at all.
Prior to PCI, all patients received adequate loading doses of Clopidogrel (600mg) or Ticagrelol (180mg) and 70IU/kg intravenous bolus of unfractionated heparin. Patients with failed PCI were excluded.
Patients in both groups were given antiplatelets including aspirin and either Ticagrelor or Clopidogrel, maximum tolerated dose of B-blockers and ACEI, and all patients were given high dose statins.