Excimer laser coronary angioplasty versus manual aspiration thrombectomy in patients with ST-segment elevation myocardial infarction: analyzed by nuclear scintigraphy.

Clinical outcomes concerning the efficacy of excimer laser coronary angioplasty (ELCA) in real-world cases of acute myocardial infarction (MI) are limited. We evaluated and compared the impact of ELCA with manual aspiration thrombectomy on myocardial salvage and left ventricular (LV) systolic/diastolic function in patients with ST-segment elevation MI (STEMI) using nuclear scintigraphy.  We enrolled 143 consecutive patients with STEMI treated with ELCA (63 patients) or manual aspiration thrombectomy (80 patients) between September 2016 and December 2020 in a single-center hospital. We evaluated the peak creatine kinase (CK)/ creatine kinase-myocardial band (CK-MB) levels and performed single-photon emission computed tomography (SPECT) analyses with Quantitative Gated SPECT and Quantitative Perfusion SPECT (Auto QUANT 7.2) at 3-10 days using 123I-BMIPP and 3 months following percutaneous coronary intervention using 99mTc-tetrofosmin to evaluate myocardial salvage and LV systolic/diastolic function. No significant difference was observed in the patient and periprocedural characteristics. Peak CK-MB level was significantly different between the groups (ELCA group, 190.0 [70.5-342.0] IU/L vs. aspiration group, 256.5 [157.0-354.8] IU/L, p = 0.047). Although no significant difference was observed in myocardial salvage, significant improvement in the LV ejection fraction (14.1 [6.2-19.8]% vs. 9.5 [3.9-15.3]%, respectively, p = 0.018) and peak emptying rate (-0.54 [-1.02- (-0.27)] mL/s vs. -0.38 [-0.76- (-0.05)] mL/s, respectively, p = 0.017) were detected. ELCA could suppress the myocardial deviation enzymes and potentially improve systolic function compared to manual aspiration thrombectomy in patients with STEMI.

High Internal Atrial Defibrillation Threshold Is Related to a High Risk of Recurrence After Catheter Ablation for Long-Standing Persistent Atrial Fibrillation But Not for Persistent Atrial Fibrillation.

BACKGROUND: The atrial defibrillation threshold (ADFT) for internal cardioversion is theoretically related to the critical mass for sustaining atrial fibrillation (AF). OBJECTIVE: This study aimed to investigate the association of ADFT for internal cardioversion with the outcome of catheter ablation for non-paroxysmal AF (non-PAF). METHODS: We included 368 consecutive patients who underwent first-time catheter ablation for non-PAF. Based on the degree of ADFT recorded by the internal cardioversion before pulmonary vein isolation, we divided the patients into low ADFT (<20 J) and high ADFT (≥20 J) groups and analysed the association between ADFT and atrial tachyarrhythmia recurrence. RESULTS: There were 234 and 134 patients in the low and high ADFT groups, respectively. Of these, 39 patients (16.7%) and 41 (30.6%) patients, respectively, had atrial tachyarrhythmia recurrence during the 2.6±1.0 year follow-up. The high ADFT group showed a significantly higher atrial tachyarrhythmia recurrence than the low ADFT group (p=0.002). This finding was also noted in patients with long-standing persistent AF (p=0.032) but not in patients with persistent AF (p=0.159). The significant predictors of arrhythmia recurrence on multivariate analysis were high ADFT (p=0.004) and long-standing persistent AF (p=0.011). In multivariate analysis within the long-standing persistent AF group, only ADFT remained a significant risk factor for AF recurrence (p=0.035). CONCLUSIONS: The high ADFT of internal cardioversion was found to be a risk factor for post-catheter ablation recurrence in patients with long-standing persistent AF but not in those with persistent AF.

Paradoxical high augmentation index in females with diabetes mellitus.

The relationship between diabetes mellitus (DM) and augmentation index (AIx) remains unclear. We conducted an observational cross-sectional study. Subjects were patients who underwent coronary angiography. We examined the relationship between high AIx and several factors. The total number of diabetic patients was 144, and median AIx was 0.256. In diabetic patients, the significant relationship between female gender and high AIx (median cut-off value, ≥0.256) was found by the multivariate logistic analysis (adjusted odds ratio = 2.888; 95% confidence interval: 1.032-8.081). The significant relationship between female gender and high AIx was found in patients with DM.

Hydrophilic polymer embolization: another differential diagnosis of iatrogenic leg embolization after transcatheter aortic valve replacement.

In daily practice, the iatrogenic complication hydrophilic polymer embolization (HPE) is under-recognized. An 86-year-old male experienced a distal foot embolization after transcatheter aortic valve replacement. Rashes appeared only in the access side foot just after the procedure. Gradual worsening of the rashes was first thought to be cholesterol crystal embolization (CCE), but a pathological examination revealed HPE. The clinical course following the diagnosis was uneventful without notable treatment. We experienced a rare but important alternative differential diagnosis of CCE after catheter intervention.

CoreValve Prosthesis Depth: What is the Optimal Measurement Target?

BACKGROUND AND AIM OF THE STUDY: A major drawback of the transcatheter aortic valve replacement (TAVR) procedure using the self-expandable Medtronic CoreValve (MCV) prosthesis is the high incidence of conduction disturbances and the need for postprocedural permanent pacemaker (PPM) implantation. The depth of prosthesis implantation may be an important contributing factor. The study aim was to determine the relationship between angiographic measurements of the MCV prosthesis depth and the occurrence of new conduction disturbances and need for PPM after TAVR. METHODS: A retrospective analysis was conducted of 157 consecutive patients who had undergone TAVR procedures with the MCV between 2009 and 2013. Patients with pre-existing pacemakers (n = 27) were excluded. Prosthesis depth was defined as the angiographic distance from the lowest part of the prosthesis to the base of the non-coronary cusp (NCcD) and the base of the left coronary cusp (LCcD). RESULTS: A 26 mm MCV was implanted in 50% of patients, and a 29 mm MCV in 38%. The rate of new ≥2nd degree atrioventricular block (AVB) after TAVR was 5%, and the incidence of new left ventricular bundle branch block (LBBB) was 23%. PPMs were implanted in 13 patients (10%) within 30 days after the procedure. Freedom from new ≥2nd degree AVB, LBBB and the need for PPM after TAVR was significantly higher among patients with NCcD <6 mm or LCcD <8 mm (90% and 89%, respectively) compared to patients with NCcD ≥6 mm or LCcD ≥8 mm (53% and 54%, respectively) (p <0.0001). CONCLUSIONS: Prosthesis depth, measured relative to either the NCcD or LCcD, strongly predicted the occurrence of conduction disturbances and the need for PPM following TAVR with the MCV prosthesis.

Use of the Rigid Table Mount System During Transcatheter Aortic Valve Replacement With the Direct Aortic Approach.

Although the direct aortic approach is one option in performing transcatheter aortic valve replacement, it is essential to keep a sheath manually in the same position during the procedure. Holding the sheath by hand is not ideal because of the relatively high dose of radiation to the person who holds the sheath. We here describe a unique way to keep the sheath firm with a table mount system.

Impact of the augmentation time ratio on direct measurement of central aortic pressure in the presence of coronary artery disease.

The augmentation index measured by using the central artery pressure is associated with an increased risk of coronary artery disease (CAD). However, no study has examined the role of the time duration of the central artery pressure on CAD. Therefore, we evaluated the relationship between the central blood pressure time duration and the presence of CAD. All patients without a history of revascularization or prior myocardial infarction who underwent an elective coronary angiography at one of the two hospitals from January to September 2013 were analyzed. CAD was defined as a significant stenosis in one of the main coronary branches. The augmentation time ratio was defined as the ratio of the reflection to peak systolic time T2T1 duration divided by the peak systolic time to aortic notch T3T2 duration. We analyzed the relationship between the central pressure waveform (not only augmentation pressure) and the presence of CAD. A total of 146 (57.3%) out of 255 patients had a significant CAD. T2T1 duration was longer in the CAD group than the no CAD group, and the T3T2 duration was shorter in the CAD group than the no CAD group. The augmentation time ratio (T2T1/T3T2) was significantly larger in the CAD group than in the no CAD group. The augmentation index and augmentation pressure were lower in the no CAD group, but this difference was not statistically significant. The augmentation time ratio was an independent factor related to no CAD, especially in patients with a high augmentation index (odds ratio, 2.17; 95% confidence interval, 1.02-4.63). The augmentation time ratio was an independent factor related to the presence of CAD.

Impact of adiponectin and leptin on long-term adverse events in Japanese patients with acute myocardial infarction. Results from the Nagoya Acute Myocardial Infarction Study (NAMIS).

BACKGROUND: Low adiponectin levels and high leptin levels are associated with a high incidence of developing cardiovascular disease. However, the relationship between the levels of these adipokines and the development of adverse events after acute myocardial infarction (AMI) remains unclear. METHODS AND RESULTS: This study enrolled 724 Japanese subjects with AMI who underwent successful emergency percutaneous coronary intervention (PCI). Their serum adiponectin and leptin levels were measured 7 days after AMI onset. There were 63 adverse events during the 3-year follow-up. The levels of adiponectin and leptin and the leptin to adiponectin ratio, were significantly associated with adverse events [hazard ratio 2.08 (95% confidence interval (CI) 1.33-3.24), P=0.001; hazard ratio 0.62 (95% CI 0.43-0.90), P=0.012; hazard ratio 0.59 (95% CI 0.45-0.76), P<0.001, respectively]. The leptin to adiponectin ratio remained a significant independent predictor of adverse events during long-term follow-up in a multivariable analysis [adjusted hazard ratio 0.60 (95% CI 0.43-0.83), P=0.002]. CONCLUSIONS: Higher adiponectin and lower leptin levels are associated with a high incidence of adverse events in Japanese patients after AMI, and the leptin to adiponectin ratio independently predicts prognosis after AMI.

Impact of low levels of vascular endothelial growth factor after myocardial infarction on 6-month clinical outcome. Results from the Nagoya Acute Myocardial Infarction Study.

BACKGROUND: Vascular endothelial growth factor (VEGF) is induced by myocardial ischemia and is thought to facilitate cardiovascular repair after acute myocardial infarction (AMI). However, the association between the plasma VEGF levels and clinical outcome in AMI patients is unclear. METHODS AND RESULTS: We evaluated 879 AMI patients undergoing successful primary revascularization within 24h of symptom onset. The patients were classified into 3 groups according to tertiles of plasma VEGF levels at 7 days after the onset of AMI. Major adverse cardiovascular and cerebrovascular events (MACCE), defined as cardiac death, recurrent acute coronary syndrome, hospital readmission for heart failure, or stroke, were assessed during the 6-month follow-up period. The incidence of MACCE was the least frequent in the middle tertile. Compared to the middle tertile, patients in the low tertile were at a significantly higher risk for MACCE even after adjusting for baseline characteristics (hazard ratio [HR] 2.67, 95% confidence interval [CI] 1.18-6.06, P=0.019). An absence of statin treatment before onset and a younger age (HR 0.54, 0.87; 95%CI 0.33-0.90, 0.76-0.99; P=0.017, 0.037; respectively) were significantly associated with low VEGF. CONCLUSIONS: Low plasma VEGF levels at 7 days after the onset of AMI were associated with a significantly increased risk for MACCE during 6 months of follow-up.

Higher dietary intake of alpha-linolenic acid is associated with lower insulin resistance in middle-aged Japanese.

OBJECTIVE: To investigate the associations between dietary intake of n-3 polyunsaturated fatty acids (plant-derived alpha-linolenic acid: ALA, and marine-derived eicosapentaenoic and docosahexaenoic acid: EPA+DHA) and insulin resistance (IR) in a lean population with high n-3 PUFA intake. METHOD: We cross-sectionally studied 3383 Japanese local government workers aged 35-66 in 2002. IR was defined as the highest quartile of homeostasis model assessment, and nutrient intake was estimated from a diet history questionnaire. The odds ratios (ORs) of IR taking the lowest quartile of ALA or EPA+DHA intake as the reference were calculated by logistic regression analysis. RESULTS: Mean age, body mass index (BMI), and dietary ALA, and median of dietary EPA+DHA were 47.9 years, 22.9 kg/m(2), and 1.90 g/day (0.88%E) and 0.77 g/day (0.36%E), respectively. The ORs of IR decreased across the quartiles of ALA intake (multivariate-adjusted OR for Q4 versus Q1=0.74, P for trend=0.01) and the association was observed only in subjects with a BMI of <25 kg/m(2) (P for interaction=0.033). However EPA+DHA showed no such associations consistently. CONCLUSION: Higher ALA intake was significantly associated with a lower prevalence of IR in normal weight individuals of middle-aged Japanese men and women.

Changes in activities of daily living, physical fitness, and depressive symptoms after six-month periodic well-rounded exercise programs for older adults living in nursing homes or special nursing facilities.

A 6-month, twice weekly, well-rounded exercise program (47 sessions in total) comprised of a combination of aerobic, resistance and flexibility training was provided for institutionalized older adults aged 60 to 93. We analyzed the data of 18 older adults who could stand and had attended more than 10% of the classes (mean participation rate: 54%) to examine changes in activities of daily living (ADL), physical fitness tests and depressive moods. The mean (+/- standard deviation, range) age of the participants was 71.3 (+/- 15.6, 60-93) in men and 85.9 (+/- 5.8, 72-93) in women. Significant improvement in ADL of the hand manipulation domain and borderline significant improvement in ADL of the mobility domain were observed (McNemar test p = 0.011 and 0.072, respectively). A 6-minute walk distance increased significantly from 151.6 m to 236.6 m (p = 0.01, paired t-test), and the result of the Soda Pop test, which tests hand-eye coordination, also improved significantly from 35.2 sec to 25.3 sec (p = 0.01, paired t-test). These findings suggest that such a program could be effective in improving the ADL and physical fitness of the elderly.

Uric acid and left ventricular hypertrophy in Japanese men.

BACKGROUND: Experimental studies have reported that allopurinol protects hypertensive rats from left ventricular hypertrophy (LVH) with negligible effects on blood pressure (BP). Uric acid (UA) was thought to induce cardiomyocyte growth and interstitial fibrosis of the heart, partly via activation of the renin-angiotensin system. In the present study, the relationship between serum UA levels and electrocardiographically-diagnosed LVH (ECG-LVH) was examined in Japanese men not taking medication for hypertension (HTN), which could confound the association. METHODS AND RESULTS: A total of 3,305 male workers aged 35-66 years (mean age+/-SD, 48.0+/-7.1) were studied. LVH was defined as meeting the ECG criteria (ie, Sokolow-Lyon voltage and/or Cornell voltage QRS duration product). Subjects were divided into 3 groups by tertile of serum UA level. The highest tertile (UA range 0.39-0.65 mmol/L or 6.6-11.0 mg/dl) had a significantly increased prevalence of LVH compared with the lowest tertile independent of age, body mass index, serum creatinine level, HTN, diabetes and hyperlipidemia (odds ratio 1.58, 95% confidence interval 1.23-2.02, P<0.001). Similar results were obtained in both the normal and high BP subgroups. CONCLUSIONS: UA concentration independently and positively associated with ECG-LVH in Japanese men.

Self-reported medical history was generally accurate among Japanese workplace population.

OBJECTIVE: To assess the validity of self-reported medical history of several diseases among the Japanese population, and to clarify to what extent the self-reported year of diagnosis for chronic diseases is different from the physician's reports. STUDY DESIGN AND SETTING: Subjects were 8,947 persons who responded to questions about medical history in a self-administered questionnaire. Of them, 854 subjects reported one or more medical histories and gave permission to contact their physician. The physicians were then requested to provide information on 809 subjects. Valid responses of 714 subjects were collected. We compared the self-reported medical histories with those reported by the physician. RESULTS: Of 15 persons who reported myocardial infarction, 13 (87%) were confirmed. Angina pectoris was verified in eight out of the 11 (73%). The confirmation proportions of hypertension, diabetes, hyperlipidemia, and hyperuricemia were 97%, 96%, 95%, and 95%, respectively. The self-reported year of diagnosis was 1.70-2.49 years earlier than the physician-reported year for chronic diseases. Agreement between the self-reported and the physician-reported years was higher, the more recent the self-reported year was. CONCLUSION: Self-reported medical histories were generally accurate, especially for diseases with clear diagnostic criteria. However, investigators should be aware of the errors in reporting the year of diagnosis.

Having more healthy practice was associated with low white blood cell counts in middle-aged Japanese male and female workers.

White blood cell (WBC) count is well known to be an independent risk marker for cardiovascular disease. The aim of this study is to examine the relationships of WBC counts to seven health practices including obesity, eating habits, smoking, alcohol intake, sleeping, physical activity, and perceived mental stress, and then clustering the relevant healthy practices. The subjects were 1,492 male and 316 female Japanese workers aged 40 yr and over in 2002. Each of seven health practices from a self-administered questionnaire was categorized as a 'healthy' or 'unhealthy' practice, and WBC counts from fasting blood samples were determined by automated particle counters. The means of age and WBC counts were 49.5 yr and 5,375 cells/microl in men, and 48.6 yr and 4,890 cells/microl in women, respectively. After multivariate adjustments for all health practices and age, the estimated WBC counts were significantly lower in normal weight subjects and never or former smokers (p<0.01). Age-adjusted WBC counts decreased significantly by 204.9+/-23.7 cells/microl (means+/-SE) and 117.6+/-53.2 cells/microl for each increase in one healthy practice (p<0.05), respectively, suggesting that cultivating healthier practices would lead to lower WBC counts. This study recommends modifying unhealthy practice one by one and maintaining healthy practices as an effective strategy for the prevention of atherosclerotic diseases, in addition, to quit smoking or abstain from heavy smoking especially in men is important to prevent the low-grade inflammation.

Low leptin but high insulin resistance of smokers in Japanese men.

AIMS: To investigate the association between smoking and leptin, and to discuss their influence on diabetes in a large-scale study of Japanese men. METHODS: A cross-sectional study was carried out in 2002. The subjects were 2836 men aged 35-66. Smoking history was investigated in a self-administered questionnaire. Blood leptin, glucose and insulin were measured. RESULTS: Significant differences in leptin levels and homeostasis model assessment of insulin resistance (HOMA-IR) related to smoking status were observed (P=0.001 and P=0.008, respectively). The multivariate-adjusted geometric means of leptin in current, past and never smokers were 3.88, 4.08 and 4.12 ng/ml, respectively, while the means of HOMA-IR were 1.64, 1.61 and 1.49, respectively. The age-, body mass index-, and other lifestyle-adjusted prevalences of diabetes in current and never smokers were 9.2 and 4.7%, respectively. That of current smokers was significantly higher than in never smokers (P<0.001). The dose-dependent association found between the intensity of smoking and leptin levels in current smokers was statistically significant (P=0.030). CONCLUSIONS: The present finding may explain in part an association among smoking, leptin levels and diabetes. Smoking is one of the important modifiable risk factors for the prevention of diabetes.

Contribution of adipocytokines to low-grade inflammatory state as expressed by circulating C-reactive protein in Japanese men: comparison of leptin and adiponectin.

BACKGROUND: Circulating C-reactive protein (CRP) is a marker of inflammation and is associated with the incidence of cardiovascular events. Although it has been known that adiponectin protects, whereas leptin accelerates, the development of atherosclerotic diseases, the comparative strength of their reciprocal effects on circulating CRP remains unclear. METHODS: We studied a population of 2049 Japanese men aged 35 to 66. For all subjects, multiple regression analysis performed with log-transformed CRP concentration as the dependent variable, and with log-transformed leptin, log-transformed adiponectin, age, BMI, smoking status, and components of metabolic syndrome as independent variables. RESULTS: Both leptin (positively) and adiponectin (negatively) were significantly and independently associated with CRP concentration. The absolute value of the standardized regression coefficient (st-beta) of leptin (st-beta=0.201) was higher than that of adiponectin (st-beta=-0.082). After subjects were stratified by current BMI level, both of the adipocytokines were significantly associated with CRP concentration among subjects with BMI <25 kg/m(2), whereas only leptin was significantly associated with CRP concentration among subjects with BMI >=25 kg/m(2). CONCLUSIONS: Both leptin and adiponectin were independently associated with CRP concentration. Leptin was more strongly related to CRP levels than adiponectin was, especially among obese subjects.

Association between low birth weight and elevated white blood cell count in adulthood within a Japanese population.

BACKGROUND: Epidemiological studies have demonstrated the association between low birth weight and increased adulthood risk for cardiovascular and metabolic diseases. However, the precise mechanism underlying the association remains poorly understood. We investigated the association between birth weight and adult white blood cell (WBC) count in a Japanese population. METHODS AND RESULTS: The subjects were 779 men and 209 women aged 35-64 years. The mean WBC count was 5,283 /microl (SD: 1,326). Birth weight was divided to 6 categories: <2,500, 2,500-<2,800, 2,800-<3,000, 3,000-<3,200, 3,200-<3,500, and >3,500 g. Estimated WBC counts were 5,729, 5,341, 5,301, 5,212, 5,013 and 5,372 for the subjects with birth weights of the above respective categories (p=0.015, trend p=0.016) by one-way analysis of covariance after adjustments for sex, age, height, body mass index (BMI), lifestyles, and chronic diseases. This association was pronounced among the subjects with a BMI <25.0 kg/m2 rather than those with a higher BMI. CONCLUSIONS: These findings support the idea that part of the association of low birth weight with elevated risk for vascular and metabolic diseases in later life could be mediated by an inflammatory pathway.

Eating fast leads to insulin resistance: findings in middle-aged Japanese men and women.

OBJECTIVE: To examine relationships between speed of eating and insulin resistance. METHODS: Cross-sectional study of 2704 male (mean age and BMI: 48.2 y and 23.3 kg/m(2)) and 761 female (46.3 y and 21.8 kg/m(2)) non-diabetic Japanese civil servants, 75% clerical, and 25% manual laborers, using a two-part questionnaire on life-style factors and diet history with self-assessment of categorical speed of eating and energy intake over a 1-month period. We measured BMI, blood glucose and insulin concentrations and calculated insulin resistance using the homeostasis model assessment of insulin resistance: (HOMA-IR). RESULTS: BMI correlated with eating rate in both sexes, and with daily energy intake in men. Multiple regression analysis of log HOMA-IR by categorical speed of eating, adjusting for age, energy intake and lifestyle factors showed a statistically significant gradual increase in HOMA-IR with increases in relative eating rate in men (p<0.001, for trend) and in women (p<0.01). Adjusting for BMI, this positive relationship appeared only in men (p=0.03). CONCLUSIONS: Our results suggest that eating fast is independently associated with insulin resistance in middle-aged Japanese men and women.

Smoking status and adiponectin in healthy Japanese men and women.

BACKGROUND: Recent studies promisingly indicate that adiponectin plays an important and fundamental role in the development and progression of metabolic and atherosclerosis disorders. Smoking is known as one of the most important risk factors of atherosclerosis, and its relation with metabolic disorders has also been reported. We therefore investigated the association between cigarette smoking and adiponectin concentration in a large sample of Japanese men and women. METHOD: The cross-sectional study was carried out in 2002. The subjects were 3260 men and 953 women local government workers aged 35 to 59 in Japan. Lifestyle-related variables including detailed smoking history were inquired in a self-administered questionnaire. RESULTS: Significant differences in adiponectin levels related to smoking status were observed in both men and women (p=0.001). A dose-dependent association was found between the intensity of smoking and adiponectin levels in current smokers, and was statistically significant in men (p for trend=0.006 in the multivariate-adjusted model). Men who quit smoking for more than 20 years and women for more than 10 years had an adiponectin concentration similar to that observed in non-smokers. CONCLUSION: We not only revealed that current smoking habit was associated with low adiponectin level but also found a dose-dependent association between smoking intensity and adiponectin level in current smokers. The present finding may provide further evidence of the importance of a causal relationship between smoking status and adiponectin concentrations.

Effect of intravenous nicorandil and preexisting angina pectoris on short- and long-term outcomes in patients with a first ST-segment elevation acute myocardial infarction.

Published reports have indicated that prodromal angina before acute myocardial infarction (AMI) is associated with better outcomes and that nicorandil has cardioprotective effects on ischemic hearts. We compared cardioprotective effects of intravenous nicorandil with preconditioning effects by prodromal angina in patients with AMI who underwent percutaneous coronary intervention (PCI). In total, 368 patients with first ST-elevation AMI who underwent PCI were randomly assigned to receive nicorandil 12 mg or a placebo intravenously just before PCI. Subjects were assigned to 1 of 4 groups: 52 patients with prodromal angina were given placebo, 129 patients without prodromal angina were given nicorandil, 56 patients with prodromal angina were given nicorandil, and 131 patients without prodromal angina were given placebo. Coronary microvascular impairment after PCI was prevented at similar frequencies in groups with prodromal angina and groups on nicorandil. Five-year rates for freedom from major cardiac events were similar across groups with prodromal angina given placebo, without prodromal angina given nicorandil, and with prodromal angina given nicorandil (92.3%, 93.8%, and 92.9%, respectively) but were significantly lower in the group without prodromal angina given placebo (80.2%, p = 0.0019, 0.044, and 0.042, respectively). In conclusion, intravenous administration of nicorandil before PCI exerts pharmacologic cardioprotective effects similar to ischemic preconditioning in patients with AMI.