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

Abstract

Objective: It is widely reported that nicorandil could reduce contrast-induced nephropathy (CIN) after selective percutaneous coronary intervention (PCI) or coronary angiography. The aim of this multi-center prospective randomized controlled trial is to evaluate the efficacy of nicorandil for the prevention of CIN during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI). Methods: Patients with STEMI received primary PCI were enrolled, and they were randomly assigned into nicorandil group and placebo group, receiving intravenous nicorandil or placebo, respectively. The endpoint was the incidence of CIN, defined as an absolute increase in serum creatinine (SCr) > 0.5 mg/dl or a relative increase > 25% compared with baseline SCr. The secondary endpoints were major adverse cardiovascular events (MACEs) within a year. Results: The final study population comprised 238 randomized patients, and 226 of them (n=113 for each group) were included in the primary analysis. Compared with the placebo group, the final TIMI grade in the nicorandil group was significantly better (P = 0.001), and the incidence of CIN in nicorandil group was significantly lower (9.7% (11/113) vs. 24.8% (28/113), P = 0.003). The logistic regression analysis revealed that nicorandil was significantly associated with the decreased odds of CIN (OR: 0.379, 95% CI: 0.166-0.861, P=0.021). Nicorandil is an independent protective factor for the development of CIN in STEMI patients undergoing primary PCI. Conclusions: Our study indicated that intravenous nicorandil could prevent CIN in patients with STEMI undergoing primary PCI.