Effect of Nicorandil Administration on Preventing Contrast-Induced Nephropathy: A Meta-Analysis

Abstract

Several studies have investigated the effect of nicorandil on contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). However, the final results of these trials are not identical. This meta-analysis evaluated the role of nicorandil administration on CIN prevention. We searched databases to find randomized controlled trial (RCT) comparing nicorandil with hydration versus conventional hydration therapy on preventing CIN. Finally, 5 articles (805 patients) were included in our meta-analysis; the data showed that nicorandil was related to significant reduction in the risk of CIN (risk ratio = 0.37, 95% confidence interval [CI]: 0.22-0.61, P = .0001). We found not only the cystatin C level after operation was nonsignificant between 2 groups at the first 24 hours ( P = .65, 95% CI = -0.06 to 0.04) and 48 hours ( P = .19, 95% CI = -0.11 to 0.02) but also the serum creatinine level was nonsignificantly elevated, at 24 hours ( P = .46, 95% CI = -5.19 to 1.88) and 72 hours ( P = .49, 95% CI = -0.49 to 0.34). Our analysis suggested that the nicorandil treatment compared with conventional hydration can significantly reduce the risk of CIN.

The Ratio of Fibrinogen to Albumin as a Predictor of Contrast-Induced Nephropathy After Carotid Angiography

“…25 A meta-analysis found that, compared to conventional hydration, nicorandil therapy could significantly reduce CIN risk in patients undergoing coronary intervention. 26 A recent study demonstrated the preventive effects of alprostadil on the development of CIN in patients with renal insufficiency undergoing percutaneous coronary intervention (PCI). 27…”

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

“…The present meta-analysis has some limitations. First, we lacked relevant information to clarify whether cardiovascular comorbidities (age and diabetes), 12,36 the dose and frequency of nicorandil administration, 11 and contrast volume 37 have an impact on the efficacy of nicorandil in PMI prevention. Second, although we performed a subgroup analysis according to the diagnoses of the patients, the baseline cardiac functions differed among the enrolled patients in all 10 trials, which may account for part of the discrepancy regarding the effect of nicorandil on the PMI risk.…”

Preventive effect of nicorandil on contrast‐induced nephropathy: a meta‐analysis of randomised controlled trials

“…Previous original studies and meta-analyses have investigated various approaches to minimise the renal injury after contrast exposure. Nicorandil is primarily prescribed for patients with angina and heart failure, and 17 However, the amount of contrast agent used in each group, which may significantly affect the incidence of CIN, was not discussed in that study. 15 As no pharmacological strategies have been proven consistently effective, prophylactic hydration is treated as the cornerstone for preventing CIN in patients with renal insufficiency.…”

“…However, a recent study by Nijssen et al showed that no hydration was non-inferior and cost-saving in CIN prophylaxis compared with hydration, 16 suggesting that physicians should look for approaches that are potentially more effective in preventing CIN. Nicorandil is primarily prescribed for patients with angina and heart failure, and 17 However, the amount of contrast agent used in each group, which may significantly affect the incidence of CIN, was not discussed in that study. Besides, a dissertation was included, which was unlikely to have been fully peer-reviewed, and the result might not be final.…”