Efficacy of brain natriuretic peptide vs. nicorandil in preventing contrast-induced nephropathy: a network meta-analysis

Abstract

This study aimed to conduct a network meta-analysis (NMA) to compare the efficacy of brain natriuretic peptide (BNP) vs nicorandil for preventing contrast-induced nephropathy (CIN). Databases of Pubmed, Cochrane, Embase, Web of Science were searched by keywords for eligible studies of randomized controlled trials investigating different agents (BNP, nicorandil, nitroglycerin, intravenous saline) for preventing CIN. The outcomes included a change in serum creatinine level at 48 h and the incidence of CIN after percutaneous coronary intervention (PCI) or coronary angiography (CAG). A total of 13 studies with 3,462 patients were included. Compared with intravenous saline alone, except for nitroglycerin (odds ratio [OR]: 1.02, 95% CI [0.36–2.88]), the other drugs significantly reduced the CIN incidence with OR of 0.35 (95% CI [0.24–0.51]) for BNP, 0.52 (0.29, 0.94) for usual-dose nicorandil, 0.28 (0.19, 0.43) for double-dose nicorandil. BNP and double-dose nicorandil significantly decreased the change of serum creatinine (SCr) levels with mean difference (MD) of −6.98, (−10.01, −3.95) for BNP, −8.78, (−11.63, −5.93) for double-dose nicorandil. No significant differences were observed in the change of SCr levels for nitroglycerin (−4.97, [−11.46, 1.52]) and usual-dose nicorandil (−2.32, [−5.52, 0.89]) compared with intravenous saline alone. For double-dose nicorandil, the CIN incidence and the change of SCr level in group of 4–5 days treatment course were more than group of less than or equal to 24 h treatment course (OR of 1.48, [0.63–3.46] and MD of 2.48, [−1.96, 6.91]). In conclusion, BNP and double-dose nicorandil can have effects on preventing the incidence of CIN and double-dose nicorandil performed better than BNP. In double-dose nicorandil groups, a course of less than or equal to 24 h before and after procedure performed with better efficacy than a course of 4–5 days.

Efficacy of Nicorandil in Preventing Contrast-Induced Nephropathy in Patients with ST-segment Elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention

“…Previous studies have demonstrated that the incidence of CIN uctuates from 6-22% in patients undergoing primary PCI [1][2][3][4] , and in our study, the incidence of CIN in the placebo group was more than 20%. Although the mechanism of CIN is not fully understood, it is believed that this complication is closely related to renal ischemic injury and the direct renal tubular cytotoxicity of contrast medium 15 .…”

“…CIN is associated with prolonged hospitalization, increased risk of adverse cardiovascular events, as well as short-and long-term mortality [1][2] . Some studies are exploring effective prevention for CIN [3][4][5] . To assess the efficacy of nicorandil for CIN prevention in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI, we analyzed a multi-center prospective randomized controlled trial, which explored the effects of nicorandil administration on infarct size in patients with STEMI treated with PPCI (primary PCI) 6 .…”