The no-reflow phenomenon is characterized by inadequate myocardial perfusion without angiographic manifestations of mechanical vascular occlusion. The phenomenon occurs after coronary vascular interventions. The development of the no-reflow phenomenon significantly worsens clinical evolution of disease increasing the number of cases of congestive heart failure and hospital mortality. Changes of endothelial function and morphology, changes of blood rheology and microvascular autoregulation are important for pathogenesis of the phenomenon. 

              Pharmacological drug management has been the sheet anchor of modern therapy utilized  in the cath lab to manage no reflow in acute setting. The treatment include intracoronary introduction of verapamil, adenosine, intravenous introduction of activators of KATP channels (nicorandil), inhibitors of glycoprotein IIb/IIIa receptors. Drugs are administered by intracoronary route and delivered directly into the IRA by guiding catheter or through infusion catheters, since the drugs given intravenously may not reach the target site due to microvascular obstruction in no reflow. Intravenous nicorandil infusion with percutaneous coronary intervention (PCI) has been reported to reduce reperfusion injury events and improve cardiac function in patients with acute myocardial infarction (MI). However, there is limited information on the use of intracoronary nicorandil.

               This study is designed to determine the change in no-reflow, slow flow,when intracoronary nicorandil was administered to patients with ASTEMI undergoing primary PCI.

OBJECTIVES:To find out improvement in thrombolysis in myocardial infarction (TIMI) flow  grade after PCI in subjects treated with intracoronary nicorandil compared to controls.