Background: Nicorandil has been demonstrated to have a cardioprotective effect, when used in conjunction with primary percutaneous coronary intervention (PCI). Even over the long term, PPCI using intravenous and intracoronary forms have evidence that it improves cardiac function and lessen the effects of reperfusion injury. There is however little data on role of oral form in ST segment elevation myocardial infarction (STEMI) patients. Objective: The purpose of this trial was to determine whether giving a single oral dosage of nicorandil before primary PCI had any cardioprotective effects on patients who had their first anterior STEMI following the onset of symptoms by six hours. Patients and Methods: 80 patients who had undergone primary PCI as a mean of reperfusion for first attack of anterior STEMI were enrolled in the study. The patients were split into two equal groups: Nicorandil 20 mg single oral dose was given to group A, the study group, and group B, the control group, didn't receive nicorandil. Results: Group A had higher left ventricle ejection fraction, (43.550 % ± 5.114) compared to control (40.325 % ±5.753), (P=0.010), lower peak values of cardiac enzymes, CK total levels peaked at 1899.1 U/L ± 601.000 compared to control [2386.300 U/L ± 844.318, (P=0.004)], peak level of CK MB was 264.100 U/L ± 86.982 compared to control [329.325 U/L ± 147.404 (P=0.018)]. Conclusion: Before reperfusion with primary PCI, giving 20 mg single oral dose of nicorandil in the first six hours in patients presenting with a first attack of anterior STEMI, had a significant cardioprotective effect, as shown by higher left ventricular ejection fraction and lesser release of cardiac enzymes, indicating less myocardial damage caused by reperfusion and greater myocardial salvage of the area at risk.