{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:07:19Z","timestamp":1776834439789,"version":"3.51.2"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Microvascular dysfunction remains a major driver of adverse outcomes after ST-segment elevation myocardial infarction (STEMI) despite successful restoration of epicardial patency by primary percutaneous coronary intervention (PCI). Nicorandil has nitrate-like vasodilatory properties and ATP-dependent potassium channel (KATP)-opening properties, effects that may improve reperfusion physiology. However, its effects on wire-free, angiography-derived measures of microvascular function are not well defined. We evaluated whether intracoronary nicorandil administered during primary PCI improves angiography-derived microvascular function assessed by angiographic microcirculatory resistance (AMR) and quantitative flow ratio (QFR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective, single-center randomized trial, 63 patients with first-episode STEMI undergoing primary PCI were allocated 1:1 to intracoronary nicorandil (2\u2005mg after guidewire crossing;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200932) or control (standard PCI;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931). The prespecified primary endpoint was final post-PCI AMR. QFR-derived indices, reperfusion measures [Thrombolysis in Myocardial Infarction (TIMI) flow grade, no-reflow, ST-segment resolution], hemodynamics, biomarkers, and clinical events were analyzed as secondary\/exploratory outcomes, with multiplicity controlled using the Benjamini\u2013Hochberg false discovery rate (FDR) where applicable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were balanced between groups. Compared with control, intracoronary nicorandil was associated with a higher rate of post-PCI TIMI grade 3 flow (96.9% vs. 74.2%; overall\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.013). Final AMR was significantly lower in the nicorandil group (1.4\u2009\u00b1\u20090.5 vs. 2.7\u2009\u00b1\u20090.5;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Vessel QFR and change in QFR (\n                      <jats:italic>\u0394<\/jats:italic>\n                      QFR) also favored nicorandil (both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), whereas residual QFR showed only a borderline\/non-significant difference after FDR correction (raw\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.027; q\u2009=\u20090.051). Peak creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) were numerically lower with nicorandil but not statistically different; left ventricular ejection fraction (LVEF) at 1 week was similar between groups. Rates of intra-procedural hypotension, in-hospital major adverse cardiovascular events (MACE), and MACE at 3-month follow-up did not differ.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this pilot randomized study, intracoronary nicorandil administered during primary PCI was associated with improved angiography-derived surrogate indices of microvascular resistance and epicardial physiology without an observed increase in peri-procedural hemodynamic instability or short-term adverse events. These findings should be interpreted as exploratory and warrant confirmation in larger multicenter studies with longer follow-up and outcome-linked validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1786130","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:32:08Z","timestamp":1776832328000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intracoronary nicorandil improves coronary microcirculatory function after primary PCI in first-episode STEMI: an angiography-derived evaluation using AMR and QFR"],"prefix":"10.3389","volume":"13","author":[{"given":"Qing","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Shaowu Municipal Hospital of Fujian Province","place":["Shaowu, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shaowu Municipal Hospital of Fujian Province","place":["Shaowu, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiashi","family":"Ding","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feifei","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shaowu Municipal Hospital of Fujian Province","place":["Shaowu, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shaowu Municipal Hospital of Fujian Province","place":["Shaowu, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shikun","family":"Chen","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiling","family":"Zhan","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenqin","family":"Cai","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaqi","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shaowu Municipal Hospital of Fujian Province","place":["Shaowu, Fujian, 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