Evaluation efficacy of nicorandil combined with trimetazidine for unstable angina using Holter electrocardiography and serum biomarkers

This study aimed to investigate the efficacy of nicorandil (NCR) combined with trimetazidine (TMZ) in treating unstable angina (UA) through a comprehensive assessment method based on Holter electrocardiography (Holter ECG) and serum biomarkers. A total of 135 UA patients were randomly allocated to four groups: CT group (conventional treatment; n = 28), NCR group (n = 30), TMZ group (n = 32), and NCR + TMZ group (combination of NCR and TMZ; n = 45). All patients received a 14-day treatment, and clinical efficacy was compared. Holter ECG was used to detect total ischemic burden (TIB), standard deviation of all normal-to-normal intervals (SDNN), percentage of adjacent normal-to-normal intervals differing by more than 50 ms (pNN50), 24-h spectral power (24h SP), maximum hourly spectral power (HSP max ), minimum hourly spectral power (HSP min ), Tp-Te interval, and P-wave dispersion (Pwd). Lipid levels and serum biomarkers, including angiopoietin-2 (Ang-2), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), von Willebrand factor (vWF), matrix metalloproteinase-9 (MMP-9), lipoprotein-associated phospholipase A2 (Lp-PLA2), cardiac troponin I (cTnI), and creatine kinase-MB (CK-MB), were measured before and after treatment. Compared with conventional treatment, NCR, TMZ, and NCR + TMZ all significantly improved the overall effective rate of treatment ( P < 0.05). After treatment, TIB, Tp-Te interval, and Pwd were significantly reduced, while SDNN, pNN50, 24h SP, HSP max , and HSP min were significantly increased; Lipid levels were significantly improved, and serum levels of TNF-α, IL-6, Ang-2, vWF, MMP-9, Lp-PLA2, cTnI, and CK-MB were significantly decreased ( P < 0.05). The NCR + TMZ group had the best overall effective rate, the greatest improvement in Holter ECG indicators, and the most optimal serum biomarker levels ( P < 0.05). Based on Holter ECG and serum biomarkers, the combination of NCR and TMZ significantly improves clinical outcomes in UA patients by reducing myocardial ischemic burden, improving autonomic nerve function, regulating vascular endothelial status, inhibiting inflammatory reactions, and reducing myocardial injury.