russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLCrussjcardiol-1288Research ArticleКЛИНИКА И ФАРМАКОТЕРАПИЯGUIDELINES FOR THE PRACTITIONERСНИЖЕНИЕ СМЕРТНОСТИ ПОСЛЕ ОСТРОГО ИНФАРКТА МИОКАРДА СВЯЗАННОЕ С ПЕРОРАЛЬНОЙ ТЕРАПИЕЙ НИКОРАНДИЛОМ ПРИ ВЫПИСКЕ ИЗ СТАЦИОНАРАORAL TREATMENT WITH NICORANDIL AT DISCHARGE IS ASSOCIATED WITH REDUCED MORTALITY AFTER ACUTE MYOCARDIAL INFARCTIONСакатаЯ.SakataY.НакатаниД.NakataniD.ШимицуМ.ShimizuM.СуннаШ.SunaSh.УсамиМ.UsamiM.МатсумотоС.MatsumotoS.ХараМ.HaraM.СумитсуйС.SumitsujiS.КаваноШ.KawanoSh.ИвакураК.IwakuraK.ХамасакиТ.HamasakiT.СатоХ.SatoH.НантоШ.NantoSh.ХориМ.HoriM.КомуроИ.KomuroI.Кафедра кардиоваскулярной медицины, Высшая школа медицины Университета Осаки, ОсакаЯпонияDepartment of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, JapanJapanКафедра кардиоваскулярной медицины, Высшая школа медицины Университета Осаки, Осака Кафедра передовой кардиоваскулярной терапии, Высшая школа медицины Университета Осаки, ОсакаЯпонияDepartment of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, OsakaJapanКардиоваскулярное отделение, Главный госпиталь Kawachi, ОсакаЯпонияCardiovascular Division, Kawachi General Hospital, Higashi-osaka, OsakaJapanКардиологическое отделение, Госпиталь им. Sakurabashi Watanabe, ОсакаЯпонияDivision of Cardiology, Sakurabashi Watanabe Hospital, Osaka, OsakaJapanОтдел биомедицинской статистики, Высшая школа медицины Университета Осаки, ОсакаЯпонияDepartment of Biomedical Statistics, Osaka University Graduate School of Medicine, Suita, OsakaJapanШкола по изучению социального обеспечения в центрах здоровья и клиниках, Университет Kwansei Gakuin, ОсакаЯпонияSchool of Human Welfare Studies Health Care Center and Clinic, Kwansei Gakuin University, Nishinomiya, OsakaJapanМедицинский центр по изучению рака и кардиоваскулярных заболеваний, ОсакаЯпонияOsaka Medical Center for Cancer and Cardiovascular Disease, Osaka, OsakaJapan201228102012059097Copyright © Саката Я., Накатани Д., Шимицу М., Сунна Ш., Усами М., Матсумото С., Хара М., Сумитсуй С., Кавано Ш., Ивакура К., Хамасаки Т., Сато Х., Нанто Ш., Хори М., Комуро И., 20122012Саката Я., Накатани Д., Шимицу М., Сунна Ш., Усами М., Матсумото С., Хара М., Сумитсуй С., Кавано Ш., Ивакура К., Хамасаки Т., Сато Х., Нанто Ш., Хори М., Комуро И.Sakata Y., Nakatani D., Shimizu M., Suna S., Usami M., Matsumoto S., Hara M., Sumitsuji S., Kawano S., Iwakura K., Hamasaki T., Sato H., Nanto S., Hori M., Komuro I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/1288

Введение. В ранее выполненных исследованиях было продемонстрировано, что терапия никорандилом способна снижать частоту коронарных событий у пациентов с ишемической болезнью сердца (ИБС). В то же время остается открытым вопрос о том, снижает ли пероральная терапия никорандилом показатели смертности после перенесенного острого инфаркта миокарда (ОИМ). Методы и результаты. Нами было изучено влияние пероральной терапии никорандилом на частоту сердечно-сосудистых событий у 1846 больных ОИМ, которые были госпитализированы в первые 24 ч после развития инфаркта, перенесли экстренное чрескожное коронарное вмешательство (ЧКВ) и были выписаны из стационара живыми. Участники исследования были разделены на две группы: группа N (n=535), при выписке получавшая пероральную терапию никорандилом, и группа C (n=1311), на момент выписки не получавшая никорандил. Обе группы достоверно не различались по возрастно-половому составу, индексу массы тела, распространенности факторов коронарного риска и наличию инфаркта в анамнезе. В то же время в группе N наблюдалась большая частота многососудистого поражения коронарных сосудов и мень- шая частота успешно выполненных ЧКВ. За время периода наблюдения (340– 1088 дней; медиана 709 дней) частота смерти от любых причин в группе N была на 43% ниже, чем в группе C (2,4% против 4,2%, соответственно; р=0,0358 для стратифицированного лог-ранг теста). По данным многомерного регрессионного анализа Кокса, терапия никорандилом снижала риск смерти от любых причин после выписки из стационара (относительный риск (ОР) 0,495; 95% доверительный интервал (ДИ) 0,254–0,966; р=0,0393). При этом не наблюдалось аналогичного снижения риска таких сердечно-сосудистых событий, как повторный ОИМ, госпитализация по поводу сердечной недостаточности, инсульт и нарушения сердечного ритма. Заключение. Полученные результаты позволяют предположить, что пероральная терапия никорандилом снижает смертность после перенесенного ОИМ.

Background. Previous studies showed that nicorandil can reduce coronary events in patients with coronary artery disease. However, it is unclear whether oral nicorandil treatment may reduce mortality following acute myocardial infarction (AMI). Methods and Results. We examined the impact of oral nicorandil treatment on cardiovascular events in 1846 AMI patients who were hospitalized within 24 h after AMI onset, treated with emergency percutaneous coronary intervention (PCI), and discharged alive. Patients were divided into those with (Group N, n = 535) and without (Group C, n = 1311) oral nicorandil treatment at discharge. No significant differences in age, gender, body mass index, prevalence of coronary risk factors, or history of myocardial infarction existed between the two groups; however, higher incidences of multi-vessel disease, and a lower rate of successful PCI were observed in Group N. During the median follow-up of 709 (340–1088) days, allcause mortality rate was 43% lower in Group N compared with Group C (2.4% vs. 4.2%, stratified log-rank test: p = 0.0358). Multivariate Cox regression analysis revealed that nicorandil treatment was associated with all-cause death after discharge (Hazard ratio 0.495, 95% CI: 0.254–0.966, p = 0.0393), but not for other cardiovascular events such as re-infarction, admission for heart failure, stroke and arrhythmia. Conclusions. The results suggest that oral administration of nicorandil is associated with reduced incidence of death in the setting of secondary prevention after AMI.

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The authors declare that there are no conflicts of interest present.