A Comparison of Isosorbid Dinitrate and Nicorandil in Patients with Ischemic Heart Disease : It's Compliance and Effects on Major Cardiovascular Events

외래에 내원한 허혈성 심질환 환자에서 경구 Nitrate 제제와 Nicorandil의 비교

Background: Nitrates are the most frequently used anti-anginal drug in clinical practice. But, it has many side effects like hypotension, headache and dizziness. Nicorandil, a potassium channel opener, has not only nitrate-like effects also many cardioprotective effects. In this study, we compared the side effects, compliance and clinical effects between nitrate and nicorandil in patients with ischemic heart disease. Methods: Patients who were prescribed with isosorbid dinitrate 120mg once daily or nicorandil 5mg t.i.d at out patient clinic were investigated in this study. All patients were discharged after acute management of acute coronary syndrome. We reviewed medical records and analyzed side effects, compliance and major cardiovascular events (death, non-fatal myocardial infarction, re-admission and coronary revascularization). Results: Total 866 patients (533 nitrate group and 333 nicorandil group) were included in this study. The mean follow up duration was 18 months. During treatment, the drugs were discontinued in 19% of each group. The most common cause of drug cessation was hypotension in nitrate (13.7%) and headache in nicoradil group (12.5%). There were 34 (6.4%) major adverse cardiac events in nitrate group and 21 (6.3%) in nicorandil group, and it was not significantly different. Conclusions: In this retrospective observational study, nitrate and nicorandil showed similar rate of side effects, drug cessation and clinical effects on cardiovascular events. But, we need more time to see the difference of long-term cardiovascular effects of these drugs.