Nicorandil Reduces contrast-induced nephropathy and Enhances Renal Function in CAG/PCI Patients: Study
Researchers have found in a new study that Nicorandil administration lowers the incidence of contrast-induced nephropathy (CIN) and improves renal biomarkers in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). However further large-scale, long-term studies are needed to validate its renoprotective benefits. This study published in the journal of International Urology and Nephrology was conducted by Ahmed Ali Khan and colleagues.
The present study performed a systematic analysis to assess the efficacy and safety of nicorandil, a vasodilator that opens ATP-sensitive potassium channels on decreasing CIN. The analysis summarized data from 12 RCTs comprising 2,931 patients, comparing the effect of nicorandil on CIN occurrence, significant adverse events, and various renal markers like serum creatinine, serum cystatin C, BUN, and eGFR.
Systematic review and meta-analysis using PubMed, MEDLINE, Embase, Google Scholar, and Web of Science up to May 2024 were carried out. It included studies with only randomized controlled trials (RCTs) in patients who had CAG or PCI and took nicorandil.
The examination estimated risk ratios (RRs) and standard mean differences (SMDs) with 95% confidence intervals (CIs), employing a random-effects model for statistical pooling. Statistical heterogeneity across studies was calculated using the I² statistic to ensure credible outcomes.
Key Findings
CIN Incidence Reduction: Nicorandil reduced the occurrence of CIN by 60% (RR: 0.40; 95% CI: 0.31–0.52; p < 0.00001).
For oral nicorandil, the reduction in CIN was even more significant (RR: 0.35; 95% CI: 0.25–0.48; p < 0.00001).
Intravenous nicorandil also decreased the incidence of CIN but to a lesser degree (RR: 0.52; 95% CI: 0.30–0.92; p = 0.02).
Major Adverse Events Reduction: Oral nicorandil decreased major adverse event risk (RR: 0.71; 95% CI: 0.51–0.99; p = 0.05).
Renal Biomarkers:
Serum Creatinine: Substantially decreased at 48 hours (SMD: -0.30; 95% CI: -0.52 to -0.07; p = 0.009) and 72 hours after intervention (SMD: -0.42; 95% CI: -0.71 to -0.13; p = 0.004).
Serum Cystatin C: Substantially lower at 48 hours after intervention (SMD: -0.56; 95% CI: -1.01 to -0.01; p = 0.02).
eGFR: There was no change of statistical significance at 24 hours (SMD: 0.12; p = 0.46), 48 hours (SMD: 0.08; p = 0.58), or 72 hours (SMD: 0.34; p = 0.16).
The current study offers strong evidence that nicorandil therapy can successfully reduce contrast-induced nephropathy and renal biomarkers in patients undergoing coronary angiography and PCI.
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