Geng N, Ren L, Xu L, et al. - A significant improvement in no-reflow phenomenon as well as in major adverse cardiac events can be achieved with nicorandil administration in patients receiving primary percutaneous coronary intervention. A combination of intracoronary and intravenous administration might afford an optimal usage of nicorandil.

• A total of 18 relevant randomized controlled trials were identified from PubMed, EmBase, and Cochrane Central Register of Controlled Trials, and were analyzed.

• Nicorandil use resulted in significant decrease in the incidence of no-reflow phenomenon (OR, 0.46) and major adverse cardiac events (OR, 0.42).

• For every single outcome of major adverse cardiac events, significant improvement was evident in only heart failure and ventricular arrhythmia with no heterogeneity (OR, 0.36 and 0.43, respectively).

• A significant decrease in the incidence of major adverse cardiac events was achieved with a combination of intracoronary and intravenous nicorandil administration, with no heterogeneity (OR, 0.24).