Does Periprocedural Nicorandil Improve Cardiovascular Outcomes in Acute Myocardial Infarction? - Meta-Analysis

Abstract

BACKGROUND Nicorandil in conjunction with Percutaneous Coronary Intervention (PCI) has shown to improve the coronary reflow. It is not known if use of Nicorandil could lead to improvement in short and long-term cardiovascular outcomes. MATERIALS AND METHODS Literature evaluation was done to determine the efficacy of Nicorandil in improving the cardiovascular outcomes in Acute Myocardial Infarction (AMI) patients in the setting of PCI. The search terms used were Nicorandil and AMI and PCI using MEDLINE and Science Direct. Study Design-A systematic review and meta-analysis. RESULTS Thirteen randomised clinical trials were identified. Nicorandil significantly reduced in-hospital outcomes (RD: 0.16; 95%, CI:-0.23 to-0.09; I 2 : 95%; p<0.00001; FE model). There was a reduction in the number of patients with thrombolysis in myocardial infarction (TIMI flow ≤2) grade (RD: 0.06; 95%, CI:-0.09 to-0.02; I 2 : 95%; p=0.002; FE model). There was no significant difference in the major adverse cardiovascular events between Nicorandil and controls when assessed between 30 days to 8 months after discharge. CONCLUSION While Nicorandil clearly appears to have a benefit in improving in-hospital cardiovascular outcomes, it remains to be seen if this could translate into improved long-term cardiovascular outcomes.

<p>Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials</p>

“…However, it failed to show a beneficial effect of nicorandil on clinical outcomes, which, from the authors’ perspective, is probably due to the limited sample sizes of the included RCTs 15–28. Another study published in 2016 including 13 RCTs showed that perioperative administration of nicorandil improved in-hospital outcomes in STEMI patients undergoing PCI without significant benefit on clinical outcomes from discharge to eight months during follow-up 29. However, this meta-analysis is with some flaws since four validated RCTs16,22,23,25 were missed, while a cardiac magnetic resonance imaging sub-study of an already included RCT was repeatedly included 30.…”