Rapid Communication| Volume 240, ISSUE 2, P351-354, June 2015

Long-term effect of molsidomine, a direct nitric oxide donor, as an add-on treatment, on endothelial dysfunction in patients with stable angina pectoris undergoing percutaneous coronary intervention: Results of the MEDCOR trial



      The MEDCOR trial is a double-blind, randomized study aiming at demonstrating the superiority of molsidomine (direct NO donor) over placebo, used as add-on treatments, on improving endothelial function (EF) after 12 months, in stable angina patients undergoing percutaneous coronary intervention.


      EF was assessed by peripheral vasodilator response (i.e. Endoscore) using arterial tonometry and by several biomarkers, in terms of changes versus baseline after a one-year treatment.


      The change in Endoscore was +75 ± 130% in placebo group and +39 ± 145% in molsidomine group (p = 0.143). There was a decrease in sICAM-1 with molsidomine (−6%) and an increase with placebo (+6%). The MPO activity/antigen ratio slightly increased with placebo (+9%) and strongly decreased with molsidomine (−42%) (p = 0.020).


      The MEDCOR trial was not able to demonstrate significant differences between molsidomine and placebo for all parameters, except the MPO activity/antigen ratio which significantly decreased with molsidomine (p = 0.020 versus placebo).


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        • Kandhai-Ragunath J.J.
        • et al.
        Approaches for non-invasive assessment of endothelial function: focus on peripheral arterial tonometry.
        Neth. Heart J. 2013; 21: 214-218
        • Messin R.
        • et al.
        Efficacy and safety of molsidomine once-a-day in patients with stable angina pectoris.
        Int. J. Cardiol. 2005; 98: 79-89
        • Messin R.
        • et al.
        Tolerability to 1-year treatment with once-daily molsidomine in patients with stable angina.
        Adv. Ther. 2006; 23: 601-614
        • De Meyer G.R.
        • et al.
        Nitric oxide donor molsidomine favors features of atherosclerotic plaque stability during cholesterol lowering in rabbits.
        J. Cardiovasc. Pharmacol. 2003; 41: 970-978
        • Belhassen L.
        • et al.
        Molsidomine improves flow-dependent vasodilation in brachial arteries of patients with coronary artery disease.
        J. Cardiovasc. Pharmacol. 2000; 35: 560-563
        • Van Hove C.
        • et al.
        Long-term treatment with the NO-donor molsidomine reduces circulating ICAM-1 levels in patients with stable angina.
        Atherosclerosis. 2005; 180: 399-405
        • Barbato E.
        • et al.
        Double-blind parallel placebo-controlled study to evaluate the effect of molsidomine on the endothelial dysfunction in patients with stable angina pectoris undergoing percutaneous coronary intervention: the MEDCOR Trial.
        J. Cardiovasc. Transl. Res. 2014; 7: 226-231
        • Rubinshtein R.
        • et al.
        Assessment of endothelial function by non-invasive peripheral arterial tonometry predicts late cardiovascular adverse events.
        Eur. Heart J. 2010; 31: 1142-1148
        • Badimon L.
        • et al.
        Circulating biomarkers.
        Thromb. Res. 2012; 130: S12-S15
        • Corrado E.
        • et al.
        An update on the role of markers of inflammation in atherosclerosis.
        J. Atheroscler. Thromb. 2010; 17: 1-11
        • Schindhelm R.K.
        • et al.
        Myeloperoxidase: a useful biomarker for cardiovascular disease risk stratification?.
        Clin. Chem. 2009; 55: 1462-1470
        • Anatoliotakis N.
        • et al.
        Myeloperoxidase: expressing inflammation and oxidative stress in cardiovascular disease.
        Curr. Top. Med. Chem. 2013; 13: 115-138
        • Balciunas M.
        • et al.
        Markers of endothelial dysfunction after cardiac surgery: soluble forms of vascular-1 and intercellular-1 adhesion molecules.
        Med. (Kaunas). 2009; 45: 434-439
        • Rautou P.E.
        • et al.
        Microparticles, vascular function, and atherothrombosis.
        Circ. Res. 2011; 109: 593-606
        • Angelillo-Scherrer A.
        Leukocyte-derived microparticles in vascular homeostasis.
        Circ. Res. 2012; 110: 356-369
        • Agouni A.
        • et al.
        Microparticles as biomarkers of vascular dysfunction in metabolic syndrome and its individual components.
        Curr. Vasc. Pharmacol. 2014; 12: 483-492
        • Schiro A.
        • et al.
        Endothelial microparticles as conveyors of information in atherosclerotic disease.
        Atherosclerosis. 2014; 234: 295-302
        • Nicholls S.J.
        • Hazen S.L.
        Myeloperoxidase and cardiovascular disease.
        Arterioscler. Thromb. Vasc. Biol. 2005; 25: 1102-1111
        • Vickers A.J.
        The use of percentage change from baseline as an outcome in a controlled trial is statistically inefficient: a simulation study.
        BMC Med. Res. Methodol. 2001; 1): 6
        • Gori T.
        • et al.
        Evidence supporting abnormalities in nitric oxide synthase function induced by nitroglycerin in humans.
        J. Am. Coll. Cardiol. 2001; 38: 1096-1101
        • Thomas G.R.
        • et al.
        Once daily therapy with isosorbide-5-mononitrate causes endothelial dysfunction in humans: evidence of a free-radical-mediated mechanism.
        J. Am. Coll. Cardiol. 2007; 49: 1289-1295