Meta-analysis of Nicorandil effectiveness on myocardial protection after percutaneous coronary intervention

Zhao, Xin; Zhang, Chun-Fei; Liu, Qingjie

doi:10.1186/s12872-019-1071-x

Cited by 15 publications

(12 citation statements)

References 36 publications

(47 reference statements)

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“…Recently, several meta-analyses reported the cardioprotective effect of nicorandil in PCI 23 –28 ; however, differences should be noted between the present study and the previous studies. First, in terms of patients, Xu et al 27 and Li et al 28 involved patients requiring primary PCI, Ji et al 26 involved acute myocardial infarction patients requiring PCI, and Li et al 24 involved different kinds of CAD patients requiring PCI, although they declared that they retrieved SAP patients needing PCI.…”

Section: Discussioncontrasting

confidence: 85%

“…In contrast, we strictly selected patients undergoing elective PCI. Second, in terms of outcomes, Ye et al, 23 Zhao et al, 25 and Ji et al 26 studied the efficacy of nicorandil on myocardial enzyme levels rather than in clinical outcomes, and Li et al 24 confused the conception between myocardial infarction and PMI, while we were mainly concerned about the effect of nicorandil on the reduction of PMI risk. Third, in terms of subgroup analysis, although the previous studies conducted subgroup analyses, 23,24 the results were not further analyzed, and we performed subgroup analyses for included trials in our meta-analysis and explained the related results.…”

Section: Discussionmentioning

confidence: 97%

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Nicorandil for Periprocedural Myocardial Injury in Elective Percutaneous Coronary Intervention: A Meta-Analysis of 10 Randomized Controlled Trials

Luo

Jiang

et al. 2020

Angiology

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The clinical outcomes of nicorandil in percutaneous coronary intervention (PCI) are conflicting. We sought to evaluate the effects of nicorandil on periprocedural myocardial injury (PMI) in elective PCI. Eligible studies that reported the effect of nicorandil on PMI in elective PCI were obtained from PubMed, Web of Science, and Cochrane Library (up to October 28, 2019). The outcomes were PMI and major adverse cardiovascular and cerebrovascular events (MACCEs). Ten randomized controlled trials with 1304 patients undergoing elective PCI were evaluated. Nicorandil significantly reduced the incidence of PMI (odds ratio [OR] = 0.48; P = .0003); however, there was no significant difference in MACCEs (OR = 0.80; P = .45) between the 2 groups. Subgroup analyses showed that nicorandil significantly lowered the PMI risk when only patients with stable coronary artery disease (OR = 0.41; P = .0008) were considered and when nicorandil was administered intravenously (OR = 0.41; P = .0007) or orally (OR = 0.33; P = .0001). This meta-analysis suggests that nicorandil could reduce the incidence of PMI without increasing the occurrence of MACCEs in elective PCI. The effect of nicorandil in lowering the PMI risk is associated with the diagnosis of the patients and the route of nicorandil administration.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 97%

Nicorandil for Periprocedural Myocardial Injury in Elective Percutaneous Coronary Intervention: A Meta-Analysis of 10 Randomized Controlled Trials

Luo

Jiang

et al. 2020

Angiology

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“… 45 , 46 The beneficial effects of nicorandil combined with PCI in patients with AMI in reducing the NRP, cTFC, and MACEs, and improving the LEVF have been demonstrated in several meta-analyses. 8 , 39 , 42 , 47 The present study, which included more recent clinical trials, further proved these effects of nicorandil. As an update to other studies, we also conducted TSA to assess the possibility of the effect size of the present meta-analysis to change according to potential future data and the requirement for future data.…”

Section: Discussionsupporting

confidence: 73%

Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis

Zhou

Cheng

et al. 2020

J Int Med Res

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Objective There is controversy whether nicorandil treatment has cardioprotective effects in patients with acute myocardial infarction (AMI) following percutaneous coronary intervention (PCI). This meta-analysis was conducted to assess the efficacy of nicorandil on functional and clinical outcomes after PCI. Methods Systematic databases were searched to retrieve studies that compared the effect of nicorandil with a control group in patients with AMI who underwent PCI. Outcomes related to coronary blood flow, and functional and clinical outcomes were extracted and a meta-analysis was performed. Trial sequential analysis was conducted to estimate the required sample size for statistical power. Results Twenty-four trials involving 2965 patients with AMI were enrolled. Pooled results showed that nicorandil treatment significantly suppressed the incidence of no-reflow phenomenon and reperfusion arrhythmia after reperfusion, improved the left ventricular ejection fraction and left ventricular end-systolic volume index, and reduced major adverse cardiovascular events and cardiovascular death. Trial sequential analysis confirmed the effect of nicorandil in reducing the incidence of no-reflow phenomenon and follow-up major adverse cardiovascular events in patients with AMI after PCI. Conclusion Our findings suggest that nicorandil treatment adjunctive to reperfusion therapy improves myocardial reperfusion, cardiac function, and clinical outcomes in patients with AMI.

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“…The incidence of cardiovascular events the next year after PCI (%) Частота ССС в течение года после ЧКВ (%) [8,12].…”

Section: Discussionunclassified

The Effect of Pharmacological Preconditioning with Nicorandil before Elective Coronary Stenting on the Long-Term Prognosis of Patients with Stable Coronary Artery Disease

Соболева

Gostishchev²,

Рогоза

et al. 2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. To study nicorandil prescription effects before elective percutaneous coronary intervention (PCI) to prevent myocardial injury and 4a type acute myocardial infarction (MI, primary endpoint) and cardiovascular events (CVE) in the first year after PCI (secondary endpoint) in patients with stable coronary artery disease.Material and methods. 182 patients with stable coronary artery disease were included into the study and were randomized into two groups: nicorandil treatment group (n=90) and a control group with a standard medical treatment (n=92). Nicorandil was prescribed orally: 2 days before PCI – 30 mg/day; on the day of PCI – 20 mg 2 hours before intervention and 10 mg 6-12 hours after PCI; over the next 30 days – 30 mg/day. High sensitivity troponin I (hs-Tr) and creatine kinase-MB tests were carried out before PCI, 24 and 72 hours after the intervention; the 4a type MI was diagnosed according to the 4th Universal Definition. Non-fatal myocardial infarction, nonfatal stroke, death from cardiovascular diseases, repeat revascularization (PCI, coronary artery bypass surgery due to aggravation), hospital admissions for angina pectoris recurrence (without interventions) and death from any causes were considered as cardiovascular events. Data on adverse outcomes were collected over the hospital stay, and then 30, 180 and 365 days after the hospital discharge.Results. 4a type MI was diagnosed in 14 patients (8%), in women – 12% and in men – 6%. There was a significant decrease in the incidence of type 4a MI in the nicorandil group (n=3; 3%) compared with the control group (n=11; 12%; p=0.05). Secondary endpoint was recorded in 21% of patients. The relationship was found between 4a type MI and the incidence of CVE the next year after the PCI (p=0.01). In patients with type 4a MI CVE odd ratio increases 5.8 times with confidence interval from 1.5426 to 21.6024. According to the logistic regression analysis the significant relationship between hs-Tr growth 24 hours after the PCI and CVE incidence next year after the PCI was found with cutting value 389.8 pg/ml, AUC=0.641 (p=0.04).Сonclusion. Peroral nicorandil 30 mg/day 2 days before PCI, 20 mg 2 hours before surgery and 10 mg 6-12 hours after PCI, and 30 mg/day next 30 days after PCI decreases the risk of intraoperative myocardial injury and CVE in the next year after PCI.

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Meta-analysis of Nicorandil effectiveness on myocardial protection after percutaneous coronary intervention

Cited by 15 publications

References 36 publications

Nicorandil for Periprocedural Myocardial Injury in Elective Percutaneous Coronary Intervention: A Meta-Analysis of 10 Randomized Controlled Trials

Nicorandil for Periprocedural Myocardial Injury in Elective Percutaneous Coronary Intervention: A Meta-Analysis of 10 Randomized Controlled Trials

Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis

The Effect of Pharmacological Preconditioning with Nicorandil before Elective Coronary Stenting on the Long-Term Prognosis of Patients with Stable Coronary Artery Disease

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