Cardioprotective Effect Of Nicorandil On The Patients With Unstable Angina Pectoris And Type 2 Diabetes Mellitus

Objective:To investigate the cardioprotective effect of nicorandil on the patients with unstable angina pectoris and type 2 diabetes mellitus, to provide the basis for more effective and rational therapy.Methods: From February 2009 to October 2010 , 127 patients (101 male and 26 female, average age was 58.91±10.90 years old) with unstable angina pectoris and type 2 diabetes mellitus were enrolled into the study. All the patients were diagnosed according to the diagnostic criterion of WHO unstable angina pectoris and WHO type 2 diabetes mellitus ; The patients were excluded for any of the following reasons : cardiomyopathy , the original severe valvular heart disease , the severe heart failure , rheumatic heart disease , atrial fibrillation , atrial flutter and bundle branch block , Acute myocardial infarction , primary pulmonary hypertension , pulmonary heart disease , insulin-dependent diabetes mellitus , diabetic neuropathy , diabetic nephropathy(creatinine>136umol/L) , Immune system disease , Serious infection , anemia , bleeding , other endocrine diseases or Liver and kidney dysfunction , malignancy , Application inflammation inhibit.A total of 127 enrolled patients according to the therapeutic methods were divided into four groups: control group for group A (n=35 , treated blood glucose which diet controlled ) , glibenclamide group for group B (n=30 , treated with glibenclamide ), nicorandil group for group C (n=35 , treated with nicorandil and blood glucose which diet controlled ) , glibenclamide and nicorandil group for group D (n=27, treated with nicorandil and glibenclamide). All the patients were admitted to the based treatment of coronary heart disease after who were in hospital : antiplatelet , anticoagulation , cholesterol-lowering drugs called statins , nitrates , selective β1 receptor blocker , ACEI drugs, ARB drugs , continuing to always hypoglycemic therapy. Collected the clinical informations of all patients in each group detailed : age , gender , risk factors , myocardial enzymes , cardiac troponin I , blood lipids , blood glucose , glycated hemoglobin , a 24-hour urinary albumin excretion , echocardiography , coronary angiography and PCI , the TIMI rank of the coronary flow , lesion extent , stent types , took electrocardiogram( including surface electrocardiogram taken to investigate the extent of ischemic ST-segment depression and Holter taken to investigate the incidence of arrhythmia) and took SPECT to detect the defect of myocardial perfusion after 4 weeks. All the data were analyzed with SPSS software (version 17.0), continuous variables were presented with mean±standard deviation, multiple independent continuous variables were compared between groups with ANOVA, Categorical variables were presented with percent and compared between groups with the use of Chi-square tests or Fishers exact probability, Wilcoxon rank tests for the numerical variable data of the nonnormal distribution. A P-value of less than 0.05 was considered to be statistically significant.Results :1 There were no statistic significances among group A,group B,group C,group D on the age , gender , risk factors , blood lipids , blood glucose , glycated hemoglobin , Oral drugs .2 There were no significant differences on the Leaman scores, stent types and TIMI flow among group A,group B,group C,group D.3 The results of electrocardiogram:The results of surface electrocardiogram shown that there were significant differences on the extent of ischemic ST-segment depression (ΣST) among group A,group B,group C,group D[(0.25±0.14 VS 0.44±0.21 VS 0.16±0.09 VS 0.26±0.17)mV, X 2 = 34.25, P <0.001 ], significant difference between group A and group B was found [(0.25±0.14 VS 0.44±0.21)mV,P<0.001], significant difference between group A and group C was found[(0.25±0.14 VS 0.16±0.09)mV,P =0.004],no significant difference between group A and group D was found [(0.25±0.14 VS 0.26±0.17)mV , P =0.83],significant difference between group B and group C was found[( 0.44±0.21 VS 0.16±0.09 )mV, P <0.001], significant difference between group B and group D was found [(0.44±0.21 VS 0.26±0.17)mV,P =0.001],significant difference between group C and group D was found [(0.16±0.09 VS 0.26±0.17)mV,P =0.004].The results of surface electrocardiogram shown that there were significant differences on the areas of myocardial ischemia(NST)among group A,group B,group C,group D(2.74±1.42 VS 4.20±1.90 VS 1.97±0.98 VS 2.96±1.60, X~ 2=30.81, P <0.001)significant difference between group A and group B was found (2.74±1.42 VS 4.20±1.90 ,P <0.001),significant difference between group A and group C was found ( 2.74±1.42VS 1.97±0.98 ,P =0.006), no significant difference between group A and group D was found(2.74±1.42 VS 2.96±1.60,P =0.60), significant difference between group B and group C was found(4.20±1.90 VS 1.97±0.98 , P < 0.001), significant difference between group B and group D was found(4.20±1.90 VS 2.96±1.60,P =0.005),significant difference between group C and group D was found (1.97±0.98 VS 2.96±1.60,P =0.002).The results of Holter shown that there were no significant differences on the incidence of malignant ventricular arrhythmia among group A,group B,group C,group D(11.4% VS 16.7% VS 2.9% VS 11.1%,X~2=3.50,P=0.32).4 The results of SPECT shown: there were significant differences on the myocardial perfusion rate in the rest state among group A,group B,group C,group D[(79.71±5.18)% VS(74.77±4.71)%VS(82.68±4.52)% VS(80.18±4.02)%, F=15.97,P <0.001], significant difference between group A and group B was found [(79.71±5.18)% VS (74.77±4.71)%,P <0.001], significant difference between group A and group C was found[(79.71±5.18)% VS(82.68±4.52)%, P =0.009],no significant difference between group A and group D was found [(79.71±5.18)% VS (80.18±4.02)%,P =0.69], significant difference between group B and group C was found[(74.77±4.71)% VS(82.68±4.52)%, P <0.001], significant difference between group B and group D was found [(74.77±4.71)% VS(80.18±4.02)%,P <0.001],significant difference between group C and group D was found[(82.68±4.52)% VS(80.18±4.02)%, P =0.04].Conclusion :1 Nicorandil significantly reduced the myocardial ischemia extent of the patients with unstable angina pectoris and type 2 diabetes mellitus and glibenclamide aggravated the myocardial ischemia extent of the patients with unstable angina pectoris and type 2 diabetes mellitus.2 Nicorandil significantly improved the myocardial perfusion and reduced the myocardial ischemia areas of the patients with unstable angina pectoris and type 2 diabetes mellitus.3 Nicorandil was no significant influence on the incidence of malignant ventricular arrhythmia of the patients with unstable angina pectoris and type 2 diabetes mellitus.