Microvascular angina through the lens of nicorandil therapy

Mozhyna T.L.

Головна
Публікації
Microvascular angina through the lens of nicorandil therapy

21 лютого 2023

922

Cardiology, Rheumatology

Mozhyna T.L.

Ключові слова :

clinical guidance,

microvascular angina,

microvascular coronary dysfunction,

nicorandil

Спеціальності :

Cardiology, Rheumatology

Резюме

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.

References

1. Lindstrom M., DeCleene N., Dorsey H. et al. (2022) Global Burden of Cardiovascular Diseases and Risks Collaboration, 1990–2021. J. Am. Coll. Cardiol., 80(25): 2372–2425.
2. Kunadian V., Chieffo A., Camici P. et al. (2020) An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur. Heart J., 41(37): 3504–3520.
3. icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1752457658.
4. Fu B., Wei X., Lin Y. et al. (2022) Pathophysiologic Basis and Diagnostic Approaches for Ischemia With Non-obstructive Coronary Arteries: A Literature Review. Front. Cardiovasc. Med., 9: 731059. doi: 10.3389/fcvm.2022.731059.
5. Grigorian-Shamagian L., Oteo J., Gutiérrez-Barrios A. et al. (2023) Endothelial dysfunction in patients with angina and non-obstructed coronary arteries is associated with an increased risk of mayor cardiovascular events. Results of the Spanish ENDOCOR registry. Int. J. Cardiol., 370: 18–25. doi: 10.1016/j.ijcard.2022.10.169.
6. http://www.dec.gov.ua/wp-content/uploads/2021/12/2021_10_26_kn_stabilna-ihs.pdf.
7. Padro T., Manfrini O., Bugiardini R. et al. (2020) ESC Working Group on Coronary Pathophysiology and Microcirculation position paper on ‘coronary microvascular dysfunction in cardiovascular disease’. Cardiovasc. Res.,116(4): 741–755. doi: 10.1093/cvr/cvaa003.
8. Zhang Y., Wang X., Liu R. et al. (2021) The effectiveness and safety of nicorandil in the treatment of patients with microvascular angina: A protocol for systematic review and meta-analysis. Medicine (Baltimore), 100(2): e23888. doi: 10.1097/MD.0000000000023888.
9. Cheng K., Alhumood K., El Shaer F. et al. (2021) The Role of Nicorandil in the Management of Chronic Coronary Syndromes in the Gulf Region. Adv. Ther., 38(2): 925–948.
10. Jiang X., Wu D., Jiang Z. et al. (2021) Protective Effect of Nicorandil on Cardiac Microvascular Injury: Role of Mitochondrial Integrity. Oxid. Med. Cell Longev., 2021: 4665632.
11. Shi L., Chen L., Qi G. et al. (2020) Effects of Intracoronary Nicorandil on Myocardial Microcirculation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials. Am. J. Cardiovasc. Drugs, 20(2): 191–198.
12. Yoshihisa A., Sato Y., Watanabe S. et al. (2017) Decreased cardiac mortality with nicorandil in patients with ischemic heart failure. BMC Cardiovasc. Disord., 17(1): 141.
13. Li Y., Liu H., Peng W. et al. (2018) Nicorandil improves clinical outcomes in patients with stable angina pectoris requiring PCI: a systematic review and meta-analysis of 14 randomized trials. Expert Rev. Clin. Pharmacol., 11(9): 855–865. doi: 10.1080/17512433.2018.1508342.
14. Zong Y., Li J., Xu X. et al. (2021) Effects of nicorandil on systemic inflammation and oxidative stress induced by percutaneous coronary intervention in patients with coronary heart disease. J. Int. Med. Res., 49(12): 3000605211058873. doi: 10.1177/03000605211058873.
15. Li Y., Zhao C., Xiong C. et al. (2022) Clinical Effect of Nicorandil Combined with Aspirin in the Treatment of Myocardial Ischemia. Biomed. Res. Int., 2022: 2214411.
16. Qian G., Zhang Y., Dong W. et al. (2022) Effects of Nicorandil Administration on Infarct Size in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The CHANGE Trial. J. Am. Heart Assoc., 11(18): e026232.
17. Jia Q., Shi S., Yuan G. et al. (2020) The effect of nicorandil in patients with cardiac syndrome X: A meta-analysis of randomized controlled trials. Medicine (Baltimore), 99(37): e22167.
18. Zhang Y., Wang X., Liu R. et al. (2021) The effectiveness and safety of nicorandil in the treatment of patients with microvascular angina: A protocol for systematic review and meta-analysis. Medicine (Baltimore), 100(2): e23888. doi: 10.1097/MD.0000000000023888.
19. Yamada K., Isobe S., Ishii H. et al. (2016) Impacts of nicorandil on infarct myocardium in comparison with nitrate: assessed by cardiac magnetic resonance imaging. Heart Vessels, 31(9): 1430–1437. doi: 10.1007/s00380-015-0752-3.
20. Tarkin J., Kaski J. (2016) Vasodilator Therapy: Nitrates and Nicorandil. Cardiovasc Drugs Ther.,30(4): 367–378. doi: 10.1007/s10557-016-6668-z.
21. Ahmed L. (2019) Nicorandil: A drug with ongoing benefits and different mechanisms in various diseased conditions. Indian J. Pharmacol., 51(5): 296–301.
22. Pearce L., Carr R., Yellon D. et al. (2023) Nicorandil — an Effective Multitarget Drug for Cardioprotection? Cardiovasc. Drugs Ther., 37(1): 5–8. doi: 10.1007/s10557-022-07397-x.