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[16] - Chambless L et al. Population versus clinical view of case fatality from acute coronary heart disease: Results from the WHO MONICA
Project 1985 1990: Multinational MONItoring of Trends and Determinants in CArdiovascular Disease. Circulation 1997; 96: 3849 3859
[17] - Sans S, Kesteloot H, Kromhout D. The burden of cardiovascular diseases mortality in Europe: Task Force of the European Society of
Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Heart J 1997; 18: 1231 1248.

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[2] - Kohli RS, et al. Acute and sustained effects of isosorbide 5-mononitrate in stable angina pectoris. Am J Cardiol. 1986 Oct 1;58(9):727-31
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K. Stoschitzky1, et al. No evidence of nitrate tolerance with Nicorandil. Poster session 3.Citation: European Heart Journal 2012;Vol.32(Abstract
Supplement):470

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Horinaka S.Use of nicorandil in cardiovascular disease and its optimization.Drugs. 2011 Jun 18;71(9):1105-19

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Horinaka S.Use of nicorandil in cardiovascular disease and its optimization.Drugs. 2011 Jun 18;71(9):1105-19


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The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 2013 ESC guidelines on the management of stable 18
coronary artery disease. European Heart Journal (2013) 34, 29493003 ( : http://www.scardio.ru/content/Guidelines/IBS_rkj_7_14.pdf).




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Sekiya M, et al. J Cardiovasc Pharmacol. 2005 Jul;46(1):63-7

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Sekiya M, et al. J Cardiovasc Pharmacol. 2005 Jul;46(1):63-7

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Zhu WL, et al. Double-blind, multicenter, active-controlled, randomized clinical trial to assess the safety and efficacy of orally administered
nicorandil in patients with stable angina pectoris in China // Circ J. 2007 Jun;71(6):826-33

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Horinaka S. . // 2011; 2 (88): 82-90

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Horinaka S. . // 2011; 2 (88): 82-90

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Terkelsen CJ, et al. Mortality rates in patients with ST-elevation vs.non-ST-elevation acute myocardial infarction: observations from an unselected
cohort // Eur Heart J. 2005 Jan;26(1):18-26

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Yang J, et al Cardioprotective effects of single oral dose of nicorandil before selective percutaneous coronary intervention.
Anadolu Kardiyol Derg. 2015 Feb;15(2):125-31.

67



(per os 2 )
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Yang J, et al Cardioprotective effects of single oral dose of nicorandil before selective percutaneous coronary intervention.
Anadolu Kardiyol Derg. 2015 Feb;15(2):125-31.

68


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Yang J, et al Cardioprotective effects of single oral dose of nicorandil before selective percutaneous coronary intervention.
Anadolu Kardiyol Derg. 2015 Feb;15(2):125-31.

69

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Patel D et al.// Eur Heart J 1999; 20: 51 57

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Patel D et al.// Eur Heart J 1999; 20: 51 57

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73
Patel D et al.// Eur Heart J 1999; 20: 51 57


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