Effects of Intravenous Nicorandil on the Mid-Term Prognosis of Patients With Acute Heart Failure Syndrome

Ishihara, Shiro; Koga, Tokushi; Kaseda, Shigeru; Nyuta, Eiji; Haga, Yoshie; Fujishima, Shinichiro; Ishitsuka, Takao; Sadoshima, Seizo

doi:10.1253/circj.cj-11-1110

Cited by 16 publications

(8 citation statements)

References 34 publications

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“…Table summarizes the design and methods of the included studies. There were five randomized controlled trials (n = 271), three observational study with a control group (n = 587) (i.e., controlled studies), and 12 observational studies without a control group (n = 391) (i.e., uncontrolled studies). Table summarizes the baseline characteristics of the included study subjects.…”

Section: Resultsmentioning

confidence: 99%

Effect of Nicorandil in Patients with Heart Failure: A Systematic Review and Meta‐Analysis

Zhao

Chaugai

Chen

et al. 2014

Cardiovascular Therapeutics

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SUMMARYBackground and purpose: It is unclear whether nicorandil, a metabolic therapeutic drug, can be applied clinically to therapy of heart failure (HF). This meta-analysis evaluated therapeutic effects of nicorandil on HF patients. Experimental approach: We performed a systematic review and meta-analysis of published studies evaluating effect of nicorandil on HF patients. Studies were stratified according to controlled versus uncontrolled designs and analyzed using random-effects meta-analysis models. Key results: We identified a total of 20 studies with a total of 1222 patients. In five randomized controlled studies, nicorandil treatment resulted in reduction in all-cause mortality and hospitalization for cardiac causes (HR: 0.35, P < 0.001) and improved cardiac pump function (SMD: 0.31, P = 0.02). In 15 observational studies, nicorandil therapy increases cardiac pump function (SMD: 0.75, P < 0.001), improves NYHA functional class (WMD: À1.33, P < 0.001), decreases PCWP (WMD: À6.86 mm Hg, P < 0.001), and pulmonary arterial pressure (SMD: À0.84, P < 0.001). Conclusions and implications: The use of nicorandil in HF patients exerts substantial beneficial effects, suggesting that it may be an additional therapeutic agent for HF.

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Section: Resultsmentioning

confidence: 99%

Effect of Nicorandil in Patients with Heart Failure: A Systematic Review and Meta‐Analysis

Zhao

Chaugai

Chen

et al. 2014

Cardiovascular Therapeutics

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“…Nicorandil exerts a vasodilatory effect mainly on the systemic veins, as do conventional nitrates, but it also dilates arteries, including peripheral arteries, by opening ATPsensitive potassium channels [13]. Previous reports have indicated that intravenous administration of nicorandil in the acute phase improves cardiac output, reduces pulmonary pressure, and modulates hemodynamic parameters in patients with AHF [23]. Several potential mechanisms have been proposed for the cardioprotective effects of nicorandil: (1) reduction in pre-and afterload [24], (2) improved myocardial perfusion [25], (3) prevention of Ca 2+ overload by opening ATPsensitive potassium channels [26], and (4) free radical scavenging and neutrophil-modulating properties [27].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it seems plausible that nicorandil may have ischemic preconditioning-like effects that improve microvascular circulation during the acute phase, as myocardial flow is depressed during this period; this assumption may account for the better outcome, as was the case in the prior study [23]. 123 I-MIBG is an analogue of the adrenergic neuronblocking agent guanethidine, which is thought to utilize the same myocardial uptake and release mechanisms as norepinephrine [31].…”

Section: Discussionmentioning

confidence: 99%

Effects of adding intravenous nicorandil to standard therapy on cardiac sympathetic nerve activity and myocyte dysfunction in patients with acute decompensated heart failure

Kasama

Toyama

Funada

et al. 2015

Eur J Nucl Med Mol Imaging

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“…14 Nicorandil bolus induces prompt reduction in pulmonary capillary wedge pressure and systemic vascular resistance in acute heart failure syndrome without affecting systolic blood pressure and heart rate. 14 We started infusion before anesthesia induction. So, continued infusion of nicorandil may have created a similar effect during OPCAB, thereby reducing the incidence of IABP insertion particularly in patients of critical CAD with or without LV dysfunction.…”

Section: Possible Explanation Of This Nicorandil Effectmentioning

confidence: 99%

Nicorandil Infusion during Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion

Kumar

Deval

Saha

et al. 2016

Innovations�(Phila)

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Objective Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion. Methods Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion). Results A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206). Conclusions Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.

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Effects of Intravenous Nicorandil on the Mid-Term Prognosis of Patients With Acute Heart Failure Syndrome

Cited by 16 publications

References 34 publications

Effect of Nicorandil in Patients with Heart Failure: A Systematic Review and Meta‐Analysis

Effect of Nicorandil in Patients with Heart Failure: A Systematic Review and Meta‐Analysis

Effects of adding intravenous nicorandil to standard therapy on cardiac sympathetic nerve activity and myocyte dysfunction in patients with acute decompensated heart failure

Nicorandil Infusion during Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion

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