Effect of Nicorandil on Cardiac Sympathetic Nerve for the Patients of Acute ST Segment Elevation Myocardial Infarction
Primary Purpose
Coronary Heart Disease
Status
Unknown status
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
nicorandil
Placebo(normal saline)
Sponsored by
About this trial
This is an interventional prevention trial for Coronary Heart Disease focused on measuring nicorandil, primary percutaneous coronary intervention, acute ST segment elevation myocardial infarction, cardiac sympathetic nerve
Eligibility Criteria
Inclusion Criteria:
- acute ST-segment elevation myocardial infarction within 12 hours of symptom onset;
- Age20-80,All genders
- anterior myocardial infarction
- The first myocardial infarction
- The infarct-related artery(IRA) is totally occlusive
- Blood pressure is higher than 90/60 millimeters of mercury(mmHg)
- The time from myocardial infarction onset to reach the hospital is less than 12 hs
Exclusion Criteria:
- kidney dysfunction (creatinine >2 mg/dl),
- History of previous liver disease,
- Cardiogenic shock,
- History of myocardial infarction (MI)
- History of coronary artery bypass grafting
- History of allergic response to drugs
- Severe hypovolemia
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Nicorandil
Placebo (normal saline)
Arm Description
Patients who received intracoronary and intravenous nicorandil before and after reperfusion with primary percutaneous coronary intervention
Patients who received intracoronary and intravenous placebo before and after reperfusion with primary percutaneous coronary intervention
Outcomes
Primary Outcome Measures
Comparison of the delayed heart/mediastinum count (H/M) ratio
The delayed heart/mediastinum count (H/M) ratio was determined from 123I-meta-iodobenzylguanidine (MIBG) images
Secondary Outcome Measures
The total defect score (TDS)
The total defect score was determined from 123I-meta-iodobenzylguanidine (MIBG) images
Rate of slow re-flow/no-reflow phenomenon
TIMI myocardial perfusion grade (TMPG) of the final coronary flow in the culprit artery
Rate fo complete ST-segment resolution
ST-segment resolution >50 percent in ECG
Rate of unplanned hospitalization for heart failure
Rate of unplanned hospitalization for heart failure
The washout rate (WR)
The washout rate (WR) were determined from 123I-meta-iodobenzylguanidine (MIBG) images
The total defect score (TDS)
The total defect score was determined from 99mTc-pyrophosphate scintigraphy
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04826497
Brief Title
Effect of Nicorandil on Cardiac Sympathetic Nerve for the Patients of Acute ST Segment Elevation Myocardial Infarction
Official Title
Effects of Nicorandil on Cardiac Sympathetic Nerve Activity and Distribution in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention
Study Type
Interventional
2. Study Status
Record Verification Date
March 2021
Overall Recruitment Status
Unknown status
Study Start Date
April 2021 (Anticipated)
Primary Completion Date
December 2021 (Anticipated)
Study Completion Date
February 2022 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Xuzhou Central Hospital
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The investigators evaluate the effects of intracoronary and intravenous administration of nicorandil on cardiac sympathetic nerve activity and distribution in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention
Detailed Description
Reperfusion injury might occur in patients with acute ST segment elevation myocardial infarction undergoing the primary percutaneous coronary intervention(P-PCI),characterized by myocardial stunning, reperfusion-induced arrhythmia, microvascular dysfunction and injury of cardiac sympathetic nerve, etc.
Nicorandil is an antianginal agent with a dual mechanism of action: nitrate and K+ATP channel opener. The nitrate action causes vasodilation of systemic veins and epicardial coronary arteries, while the adenosine triphosphate (ATP)-sensitive potassium channel opener action causes vasodilation of peripheral and coronary resistance arterioles. Nicorandil not only decreases preload and afterload but also increases coronary blood flow.
The study will compare the effectiveness between nicorandil and placebo of preventing the reperfusion injury especially injury of cardiac sympathetic nerve in patients with acute ST segment elevation myocardial infarction undergoing the P-PCI.It is intended that before reperfusion injury ,nicorandil which was early used by intracoronary injection could prevent and release the microcirculatory spasm, release the coronary microvascular endothelial swelling,decrease embolism of atherosclerotic debris and thrombus formation,moreover,it could reduces the release of norepinephrine from sympathetic endings of the heart directly.So,it could decrease the phenomenon of no-reflow/slow reflow,reperfusion-induced arrhythmia and injury of cardiac sympathetic nerve.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Heart Disease
Keywords
nicorandil, primary percutaneous coronary intervention, acute ST segment elevation myocardial infarction, cardiac sympathetic nerve
7. Study Design
Primary Purpose
Prevention
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
80 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Nicorandil
Arm Type
Experimental
Arm Description
Patients who received intracoronary and intravenous nicorandil before and after reperfusion with primary percutaneous coronary intervention
Arm Title
Placebo (normal saline)
Arm Type
Placebo Comparator
Arm Description
Patients who received intracoronary and intravenous placebo before and after reperfusion with primary percutaneous coronary intervention
Intervention Type
Drug
Intervention Name(s)
nicorandil
Other Intervention Name(s)
Experiment Group
Intervention Description
All patients received antiplatelet agents (aspirin, ticagrelor) and heparin.Diagnostic coronary angiography (CAG) was performed via the radial artery using the Seldinger method.The guidewire was passed into the culprit lesion.If the blood flow of culprit vessel reaches TIMI2-3 after balloon dilatation,6mg nicorandil was then administrated before stent implantation, A minimum 5-min interval occurred between the first and second doses of nicorandil to reduce adverse effects, subsequently , 6mg/h ivgtt. up to 48h after coronary intervention
Intervention Type
Drug
Intervention Name(s)
Placebo(normal saline)
Other Intervention Name(s)
Control Group
Intervention Description
All patients received antiplatelet agents (aspirin, ticagrelor) and heparin.Diagnostic coronary angiography (CAG) was performed via the radial artery using the Seldinger method.The guidewire was passed into the culprit lesion.If the blood flow of culprit vessel reaches TIMI2-3 after balloon dilatation,6mg placebo was then administrated before stent implantation, A minimum 5-min interval occurred between the first and second doses of placebo to reduce adverse effects, subsequently , 6mg/h ivgtt. up to 48h after coronary intervention
Primary Outcome Measure Information:
Title
Comparison of the delayed heart/mediastinum count (H/M) ratio
Description
The delayed heart/mediastinum count (H/M) ratio was determined from 123I-meta-iodobenzylguanidine (MIBG) images
Time Frame
10 days after primary PCI
Secondary Outcome Measure Information:
Title
The total defect score (TDS)
Description
The total defect score was determined from 123I-meta-iodobenzylguanidine (MIBG) images
Time Frame
10 days after primary PCI
Title
Rate of slow re-flow/no-reflow phenomenon
Description
TIMI myocardial perfusion grade (TMPG) of the final coronary flow in the culprit artery
Time Frame
5 minutes after primary PCI
Title
Rate fo complete ST-segment resolution
Description
ST-segment resolution >50 percent in ECG
Time Frame
2 hours after primary PCI
Title
Rate of unplanned hospitalization for heart failure
Description
Rate of unplanned hospitalization for heart failure
Time Frame
6 months after primary PCI
Title
The washout rate (WR)
Description
The washout rate (WR) were determined from 123I-meta-iodobenzylguanidine (MIBG) images
Time Frame
10 days after primary PCI
Title
The total defect score (TDS)
Description
The total defect score was determined from 99mTc-pyrophosphate scintigraphy
Time Frame
7 days after primary PCI
10. Eligibility
Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
acute ST-segment elevation myocardial infarction within 12 hours of symptom onset;
Age20-80,All genders
anterior myocardial infarction
The first myocardial infarction
The infarct-related artery(IRA) is totally occlusive
Blood pressure is higher than 90/60 millimeters of mercury(mmHg)
The time from myocardial infarction onset to reach the hospital is less than 12 hs
Exclusion Criteria:
kidney dysfunction (creatinine >2 mg/dl),
History of previous liver disease,
Cardiogenic shock,
History of myocardial infarction (MI)
History of coronary artery bypass grafting
History of allergic response to drugs
Severe hypovolemia
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
chunguang Feng, PhD
Phone
+8618936376559
Email
fcg999@163.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Institute of Cardiovascular Disease Xuzhou Central Hospital
Organizational Affiliation
Southeast University
Official's Role
Study Director
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
28886621
Citation
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimsky P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-177. doi: 10.1093/eurheartj/ehx393. No abstract available.
Results Reference
result
PubMed Identifier
12607706
Citation
Piper HM, Meuter K, Schafer C. Cellular mechanisms of ischemia-reperfusion injury. Ann Thorac Surg. 2003 Feb;75(2):S644-8. doi: 10.1016/s0003-4975(02)04686-6.
Results Reference
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31147987
Citation
Ji Z, Zhang R, Lu W, Ma G, Qu Y. The effect of nicorandil in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Ir J Med Sci. 2020 Feb;189(1):119-131. doi: 10.1007/s11845-019-02034-3. Epub 2019 May 30.
Results Reference
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PubMed Identifier
31118574
Citation
Xu L, Wang L, Li K, Zhang Z, Sun H, Yang X. Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2019 Apr 29;13:1389-1400. doi: 10.2147/DDDT.S195918. eCollection 2019.
Results Reference
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PubMed Identifier
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Citation
Fukui Y, Nozawa T, Ihori H, Sobajima M, Nakadate T, Matsuki A, Nonomura M, Fujii N, Inoue H, Kinugawa K. Nicorandil Attenuates Ischemia-Reperfusion Injury Via Inhibition of Norepinephrine Release From Cardiac Sympathetic Nerve Terminals. Int Heart J. 2017 Oct 21;58(5):787-793. doi: 10.1536/ihj.16-391. Epub 2017 Sep 30.
Results Reference
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PubMed Identifier
15791442
Citation
Kasama S, Toyama T, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, Kurabayashi M. Effects of nicorandil on cardiac sympathetic nerve activity after reperfusion therapy in patients with first anterior acute myocardial infarction. Eur J Nucl Med Mol Imaging. 2005 Mar;32(3):322-8. doi: 10.1007/s00259-004-1672-0. Epub 2004 Oct 2.
Results Reference
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Citation
Hicks KA, Mahaffey KW, Mehran R, Nissen SE, Wiviott SD, Dunn B, Solomon SD, Marler JR, Teerlink JR, Farb A, Morrow DA, Targum SL, Sila CA, Thanh Hai MT, Jaff MR, Joffe HV, Cutlip DE, Desai AS, Lewis EF, Gibson CM, Landray MJ, Lincoff AM, White CJ, Brooks SS, Rosenfield K, Domanski MJ, Lansky AJ, McMurray JJV, Tcheng JE, Steinhubl SR, Burton P, Mauri L, O'Connor CM, Pfeffer MA, Hung HMJ, Stockbridge NL, Chaitman BR, Temple RJ; Standardized Data Collection for Cardiovascular Trials Initiative (SCTI). 2017 Cardiovascular and Stroke Endpoint Definitions for Clinical Trials. J Am Coll Cardiol. 2018 Mar 6;71(9):1021-1034. doi: 10.1016/j.jacc.2017.12.048.
Results Reference
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Effect of Nicorandil on Cardiac Sympathetic Nerve for the Patients of Acute ST Segment Elevation Myocardial Infarction
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