Nicorandil in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis

doi:10.4330/wjc.v18.i3.116789

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World Journal of Cardiology

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World J Cardiol. Mar 26, 2026; 18(3): 116789
Published online Mar 26, 2026. doi: 10.4330/wjc.v18.i3.116789

Nicorandil in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis

Shahzaib Ahmed, Eeman Ahmad, Hamza Ashraf, Hoor Ul Ain, Shoaib Ahmad, Umar Akram, Jawad Basit, Ibrahim Nagmeldin Hassan, Irfan Ullah, Raheel Ahmed, Gregg C Fonarow, Bernardo Cortese

Shahzaib Ahmed, Department of Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore 54610, Punjab, Pakistan

Eeman Ahmad, Department of Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore 54770, Punjab, Pakistan

Hamza Ashraf, Umar Akram, Department of Medicine, Allama Iqbal Medical College, Lahore 54770, Punjab, Pakistan

Hoor Ul Ain, Department of Medicine, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur 11111, Pakistan

Shoaib Ahmad, Department of Medicine, St. Joseph Hospital and Medical Center, Arizona City, AZ 85038, United States

Jawad Basit, Department of Cardiology, Rawalpindi Medical University, Rawalpindi 57440, Punjab, Pakistan

Ibrahim Nagmeldin Hassan, Department of Medicine, University of Khartoum, Faculty of Medicine, Khartoum 11111, Sudan

Irfan Ullah, Department of Medicine, Khyber Teaching Hospital, Peshawar 54770, Khyber Pakhtunkhwa, Pakistan

Raheel Ahmed, Department of Medicine, Imperial College London, London SW7 2AZ, United Kingdom

Gregg C Fonarow, Department of Medicine, Division of Cardiology/Ahmanson-UCLA Cardiomyopathy Center, California City, CA 90095, United States

Gregg C Fonarow, Ahmanson UCLA Cardiomyopathy, Univ Calif Los Angeles, Los Angeles, CA 90095, United States

Bernardo Cortese, Department of Interventional Cardiology, A.O. Fatebenefratelli, Milano 20121, Italy

Author contributions: Ahmed S contributed to project administration, formal analysis; Ahmed S and Ahmad E contributed to conceptualization; Ahmed S, Ahmad E, Ashraf H, Ahmad S, Ain HU, Akram U, and Basit J contributed to original draft; Ahmed S, Ahmad E, Ashraf H, Ain HU, Ahmad S, Akram U, Basit J, Hassan IN, Ullah I, Ahmed R, Fonarow GC, and Cortese B contributed to review and edit of the manuscript; Ashraf H, Ahmad S, Ain HU, Akram U, Basit J, Ullah I, Ahmed R, Fonarow G, and Cortese B contributed to validation; Fonarow G and Cortese B contributed to supervision. All authors have read and approved the final manuscript.

Conflict-of-interest statement: Dr. Fonarow reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Johnson and Johnson, Medtronic, Merck, Novartis, and Pfizer. None of the other authors have any interests to declare.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Ibrahim Nagmeldin Hassan, Department of Medicine, University of Khartoum, Faculty of Medicine, ElQasr Avenue, Khartoum 11111, Sudan. ibrahimnagmmrcp@gmail.com

Received: November 20, 2025
Revised: December 13, 2025
Accepted: February 12, 2026
Published online: March 26, 2026
Processing time: 123 Days and 2.9 Hours

Abstract

BACKGROUND

Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-elevation myocardial infarction (STEMI). However, its effectiveness may be limited by reperfusion injury and the no-reflow phenomenon.

AIM

To improve myocardial microvascular function and reduce no-reflow.

METHODS

A systematic search was conducted on MEDLINE, Scopus, EMBASE, and Cochrane CENTRAL from inception to January 25, 2025. Randomized controlled trials comparing nicorandil to control in STEMI patients undergoing PCI were included. Primary outcomes included ST-segment resolution, Thrombolysis in Myocardial Infarction grades, Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade, left ventricular (LV) functions, and infarct size. R version 4.4.0 was used to conduct statistical analyses. This review has been registered with PROSPERO (CRD42024614029).

RESULTS

A total of 26 randomized controlled trials involving 3258 participants were included in this review. Individuals receiving nicorandil had a higher rate of complete ST segment resolution than the control group. It significantly reduced infarct size and the LV end-systolic volume index at 6 months. Furthermore, LV ejection fraction showed significant improvement with nicorandil therapy at 1 week, 1 month, 3 months, and 6 months. Patients receiving nicorandil also had a notably higher incidence of normal epicardial flow (Thrombolysis in Myocardial Infarction grade 3) and normal tissue-level perfusion (Thrombolysis in Myocardial Perfusion grade 3) compared to controls. Additionally, nicorandil significantly lowered the risk of major adverse cardiovascular events relative to the control group.

CONCLUSION

Nicorandil improves myocardial perfusion and LV function following PCI in STEMI patients while maintaining a favorable safety profile. Further high-quality trials are needed to confirm its long-term efficacy and clinical benefits.

Keywords: Nicorandil; Percutaneous coronary intervention; ST-segment elevation myocardial infarction; Myocardial perfusion; Myocardial infarction

Core Tip: Nicorandil, a nitrate-like agent that opens adenosine triphosphate-sensitive potassium channels, has been studied as an adjunct during primary percutaneous coronary intervention for ST-elevation myocardial infarction. In this systematic review and meta-analysis of randomized trials, nicorandil improved ST-segment resolution, Thrombolysis in Myocardial Infarction grade 3 flow, and Thrombolysis in Myocardial Perfusion grade 3. It also enhanced left ventricular function and lowered major adverse cardiovascular events. These findings support its value in reducing microvascular injury and improving post-percutaneous coronary intervention outcomes.