Preventive Effects of Nicorandil Against Contrast-Induced Nephropathy in Patients With Moderate Renal Insufficiency Undergoing Percutaneous Coronary Intervention

Abstract

We investigated the preventive effect of nicorandil on contrast-induced nephropathy (CIN) in patients with moderate renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 250 patients with a creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to either a nicorandil group (nicorandil 10 mg 3 times/d and hydration; n = 125) or a control group (hydration only; n = 125). The first end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or ≥25% within 72 hours after exposure to the contrast medium. The secondary end points were (1) changes in Scr, blood urea nitrogen, and crCl and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 1.6% (2/125) in the nicorandil group and 9.6% (12/125) in the control group ( P = .011). There was no obvious difference in the incidence of major adverse events during hospitalization between the nicorandil and the control group (4.0% vs 4.8%, P = 1.000). Multivariate logistic regression analysis showed that nicorandil was a protective factor for CIN (odds ratios = 0.126, 95% confidence interval: −19.996 to −0.932, P = .012). Prophylactic administration of nicorandil may prevent against CIN in patients with moderate renal insufficiency undergoing PCI.

Efficacy and Safety of Nicorandil in Preventing Contrast-Induced Nephropathy after Elective Percutaneous Coronary Intervention: A Pooled Analysis of 1229 Patients

“…Four studies were from China [ 5 – 7 , 9 ], and the remaining studies were from Japan [ 10 ] and Iran [ 8 ], respectively. The contrast media used in all trials were iodine-based, such as iomeprol [ 10 ], iohexol [ 5 , 8 , 10 ], ioversol [ 6 ], and Ultravist [ 7 , 9 ]. All participants in nicorandil groups were treated with nicorandil; however, the route of nicorandil administration applied in these studies differed: oral administration was applied in three studies [ 6 , 8 , 9 ], and intravenous administration was applied in the others [ 5 , 7 , 10 ].…”

“…Therefore, we performed a subgroup analysis according to oral administration and intravenous administration, to evaluate the efficacy of nicorandil for CIN. Nicorandil significantly reduced the CIN through oral administration (three trials; 618 participants; OR = 0.25; 95% CI = 0.13–0.47; P < 0.0001; I 2 = 0%; Figure 2(a) ) [ 6 , 8 , 9 ] and intravenous administration (three trials; 611 patients; OR = 0.28; 95% CI = 0.12–0.66; P =0.004; I 2 = 0%; Figure 2(a) ) [ 5 , 7 , 10 ].…”

“…Data about mortality, heart failure, recurrent myocardial infarction, stroke, and renal replacement therapy were available in three trials, and recurrent myocardial infarctions were available in two trials. There was no significant difference between the groups in mortality (OR = 0.82, 95% CI = 0.19–3.55, P =0.79, I 2 = 0%) [ 6 , 7 , 9 ], heart failure (OR = 0.79, 95% CI = 0.32–1.93, P =0.60, I 2 = 0%) [ 6 , 7 , 9 ], recurrent myocardial infarction (OR = 0.35, 95% CI = 0.04–3.17, P =0.35, I 2 = 0%) [ 7 , 9 ], stroke (OR = 3.02, 95% CI = 0.31–29.28, P =0.34, I 2 = 0%) [ 6 , 7 , 9 ], and renal replacement therapy (OR = 0.47, 95% CI = 0.05–4.51, P =0.51, I 2 = 0%) [ 6 , 7 , 9 ] after elective PCI ( Figure 2(b) ).…”

Nicorandil and Contrast-Induced Nephropathy

“…We read the article “Preventive Effects of Nicorandil Against Contrast-Induced Nephropathy in Patients With Moderate Renal Insufficiency Undergoing Percutaneous Coronary Intervention” with interest. 1…”

“…Zhang et al investigated several characteristics of patients and there is a diabetic population in the nicorandil and control groups,19.2% and 23.2%, respectively. 1 But there are no details about metformin use, preprocedural glucose levels, or trimetazidine administration.…”