Intracoronary Nicorandil And The Clinical Efficacy Of The No-reflow Phenomenon After Primary Percutaneous Coronary Intervention(PCI)in Patients With Acute Myocardial Infarction:A Meta-analysis

Objective To systematically evaluate the clinical efficacy of intra-coronary injection of Nicorandil on no-reflow(NR)phenomenon after the PPCI in patients with acute myocardial infarction(AMI).Methods Relevant randomized controlled trials(RCTs)published before July 1,2019 will collected by searching The Chinese and English databases of The Cochrane Library,PubMed,Embase,Wily online library,VIP Database,CNKI,Wan Fang Database and so on.Two in-dependent researchers used RevMan5.3 to perform statistical analysis on the basis of literature screening,data extraction and quality evaluation.Results Seven RCTs consisting of 739 patients were included.The results of the Meta-analysis showed that Intracoronary Nicorandil could decrease significantly the incidence of no-reflow[RR=0.35,95%CI(0.23,0.54),P<0.00001)],reduce Corrected TIMI Frame Count(CTFC)[MD=-5.51,95%CI(-7.34,-3.69),P<0.00001],improve left ventricular ejection fraction(LVEF)[ MD=3.06,95%CI(0.70,5.42),P=0.01],gain decreasing incidence of life-threatening arrhythmia[RR=0.43,95%CI(0.20,0.92),P=0.03].Conclusion Evidence shows that intracoronary nicorandil could prevent no-reflow,reduce CTFC,improve LVEF,and reduce malignant arrhythmias(ventricular tachycardia and ventricular fibrillation)in patients with AMI after coronary stent implantation.But intracoronary nicorandil could not reduce significantly the incidence of Major adverse cardiovascular events(MACEs),excluded malignant arrhythmias.However,there is a moderate possibility of selection bias,performance bias and publication bias in this review because of the small number of the included studies,which weakens the strength of the evidence of our results.More multicenter,large sample size,high-quality RCTs are needed.