Effects of Nicorandil on All-Cause Mortality and Cardiac Events in CAD Patients Receiving PCI

Abstract

Current studies demonstrating the effects of nicorandil in the prognosis of coronary artery disease (CAD) patients who received percutaneous coronary intervention (PCI) are inconclusive due to the small sample size and small events rate. PubMed, OVID, CBM and CNKI databases were searched using a pre-specified search string to collect randomized controlled trials (RCTs) studying the effects of nicorandil on CAD patients receiving PCI. Data on all-cause mortality and cardiovascular events were collected. RevMan 5.3 software was used for meta-analysis. Subgroup analysis was conducted in patients receiving primary PCI (PPCI) and elective PCI (EPCI). A total of 18 RCTs were included in our final analysis. Nicorandil treatment significantly reduced total mortality in PPCI (Peto OR = 0.44, 95%CI 0.25-0.79, P = 0.006) and EPCI (Peto OR = 0.41, 95%CI 0.25-0.67, P = 0.0004), cardiovascular death in both PPCI (Peto OR = 0.41, 95%CI 0.20-0.84, P = 0.01) and EPCI (Peto OR = 0.40, 95%CI 0.20-0.80, P = 0.009), and heart failure in PPCI (RR = 0.36, 95%CI 0.22-0.59, P < 0.0001). When compared with placebo plus standard treatment or standard treatment alone, nicorandil plus standard treatment was associated with reduced total mortality in both PPCI and EPCI, CV death in EPCI, and heart failure in PPCI. Nicorandil is associated with lower risks of total mortality and CV death in PPCI and EPCI in those who received nicorandil > 28 days. Nicorandil as an adjunct therapy along with PCI is associated with reduced total mortality and cardiovascular death in PPCI and EPCI patients, and reduced heart failure in PPCI patients.

Assessment of cardiac parameters after the administration of nicorandil before primary percutaneous coronary intervention

“…Studies have suggested that reperfusion arrhythmias are non-invasive indicators of myocardial cell damage. 24 In the current study, no patient died and no significant changes were seen in Echo 48 hours post-PCI, but nicorandil showed overall better outcomes compared to the control group, which was in line with Zhang et al 25 The current results agreed with the findings of a randomised trial that had a 5-year follow-up in which nicorandil was given 20-30 minutes before PCI as an IV infusion of 12mg in 100ml of saline. The study found that a single dose of nicorandil improved not only early but also late clinical events, including cardiovascular death or hospital admission due to worsening congestive heart failure (CHF).…”

Nicorandil Ameliorates Doxorubicin-Induced Cardiotoxicity in Rats, as Evaluated by 7 T Cardiovascular Magnetic Resonance Imaging

“…Almost 90% of patients developing doxorubicinmediated LVEF deterioration never fully recover complete cardiac function even with these therapies. Nicorandil, the first nitrate compound and ATP-dependent potassium (K + ATP) channel opener applied clinically as a new vasodilator treatment [32,33], has multiple cardiovascular benefits for multiple heart diseases and improved cardiac function [34][35][36]. Nicorandil suppresses the inflammatory cytokines IL-1β, IL-1, IL-6, IL-10, IL-18, IL-19 and TNF-α in acute coronary syndrome patients [37].…”

Efficacy and Safety of Nicorandil for Periprocedural Myocardial Injury in Patients Undergoing Pci

“…RIPC means that non-lethal and reversible ischemia and reperfusion affecting one organ or tissue alone provide a "preconditioning" effect against a following severe ischemia-reperfusion applied to another organ or tissue, causing its hypoxic death (11). ATP-sensitive potassium channels are active in place of mitochondria, doing a job similar to that of the preconditioning of ischemic (12). Therefore, the present study focused on nicorandil efficacy and safety, which were underlined for preventing periprocedural myocardial injury in patients who had undergone PCI.…”