Microvascular angina through the lens of nicorandil therapy

February 21, 2023
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Recently, clinicians have been paying a lot of attention to microvascular angina, trying to explain the occurrence of angina pain in the absence of obstruction of large epicardial coronary arteries according to coronagraphy. Such authoritative international organizations as European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Society of Cardiology have developed and presented clear diagnostic criteria for microvascular angina, which focus on the detection of microvascular coronary dysfunction during non-invasive and invasive instrumental studies. In order to treat microvascular coronary dysfunction, the EAPSI guidelines prescribe drugs that can improve the function of the endothelium, reduce the need for oxygen, eliminate vasospasm, and reduce visceral pain perception. As the first drug of the second line of therapy, EAPSI representatives advise using nicorandil, which promotes vasodilatation and activation of ATP-dependent potassium channels, which leads to the expansion of microvessels, improvement of endothelial function and increased blood flow. The article discusses the main mechanisms of action of nicorandil and presents data from randomized controlled trials, systematic reviews and meta-analyses, which demonstrate the ability of nicorandil to improve coronary blood flow in obstructive and non-obstructive coronary heart disease.

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