Effect of nicorandil tablets on C-reactive protein to albumin ratio as a prognostic biomarker in patients undergoing primary percutaneous intervention.

Background:The gold standard for minimizing complications in ST-elevation myocardial infarction (SETMI)is primary percutaneous coronary intervention (PPCI).On the other hand,myocardial damage might result from reperfusion injury.Nicorandil may help avoid reperfusion damage due to its anti-inflammatory and cardioprotective properties.Major adverse cardiovascular events (MACE) have been associated with the C-reactive protein to albumin ratio(CAR),a biomarker that indicates inflammatory state. Aim:To evaluate the effect of nicorandil tablets on CAR as a short-term prognostic biomarker in patients presenting with STEMI undergoing PPCI and to study the effect of oral nicorandil on their clinical and angiographic results. Patients and methods:500 patients eligible to PPCI were enrolled in our study.Patients were divided into two groups: group 1(n= 250)who administered nicorandil tablets and group 2(n= 250)who received standard care therapy without oral nicorandil. ECG, Echocardiography, laboratory investigations including CRP and albumin were performed. In-hospital MACE, angiographic and PPCI data were recorded. A follow up period after 1-month to 5-point MACE and CAR were the end point of our study. Results:Group 1 had lower CAR level than group 2 after admission (5.8±0.6) vs.(12.9±1.9),P= <0.001,at discharge (5.2±0.8)vs.(13.3±1.7),P= <0.001 and after 1 month of follow up (2.14±0.36) vs. (4.5±0.48),P= <0.001.Group 1 had higher number of patients with TIMI flow 3 and myocardial blush grade 3;197(78.8%)vs.147(58.8%) and 163(65.2%) vs.119(47.6%),P= 0.003 and 0.001respectively. Group 1 had statistically significant fewer number of patients who encountered in-hospital and follow up MACE. Conclusion:Oral nicorandil administration was associated with significant reduction in CAR,better clinical and angiographic outcomes emphasizing its potential as a prognostic biomarker in PPCI patients.