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The Effect of Intracoronary Nicorandil on Coronary Myocardial Bridging

Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Republic of Korea

Pil-Ki Min, MD, PhD

Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

Chong Won Sung, MD

Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Republic of Korea

Sang-Hak Lee, MD, PhD

Cardiovascular Division of Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

Seonghoon Choi, MD

Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Republic of Korea

Jung Rae Cho, MD

Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Republic of Korea

Namho Lee, MD, PhD

Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Republic of Korea

Kyoung-Ha Park, MD

Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Republic of Korea

Min-Kyu Kim, MD, PhD

Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Republic of Korea

Woo Jung Park, MD, PhD

Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Republic of Korea

Yangsoo Jang, MD, PhD

Cardiovascular Division of Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea, jangys1212{at}yuhs.ac

Medical treatments of coronary myocardial bridging (CMB) generally include β-blockers and calcium channel blockers. Nitrates are avoided because symptoms may worsen. Nicorandil is a hybrid of a nitrate and a potassium channel opener. However, the effect of nicorandil on CMB is unknown. We analyzed nicorandil reactivity at the site with CMB in 51 patients. Maximal and minimal diameters of CMB were measured by quantitative angiography at baseline and at 60 seconds after intracoronary administration of 200 mg nicorandil. The maximal diameter during diastole increased from 2.15 + 0.42 mm to 2.34 + 0.44 mm after administration of nicorandil (P < .001), and the minimal diameter during systole increased from 1.24 + 0.63 mm to 1.67 + 0.64 mm (P < .001). Thus, nicorandil reduced the percentage vessel narrowing from 44.0 + 26.1% to 30.3 + 21.2% (P < .001). In 22 patients, we also evaluated the effect of nitroglycerin. The maximal diameter during diastole increased from 2.25 + 0.47 mm to 2.51 + 0.44 mm after administration of nitroglycerin (P < .019), and the minimal diameter during systole decreased from 1.28 + 0.64 mm to 1.14 + 0.60 mm (P = .276). Thus, nitroglycerin augmented the percentage vessel narrowing from 44.9% + 25.0% to 56.0% + 23.5% (P = .023). These results indicate that intracoronary administration of nicorandil could dilate coronary arteries during diastole as well as systole in patients with CMB during coronary angiography.

Key Words: angina pectoris • myocardial bridging • nicorandil

This version was published on September 1, 2009

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 14, No. 3, 180-184 (2009)
DOI: 10.1177/1074248409338930


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