Safety of oral nicorandil before coronary artery bypass graft surgery

Blanc, Pascale; Aouifi, A.; Bouvier, H.; Joseph, P.-A.; Chiari, Pascal; Ovize, Michel; Girard, Claude; Jegaden, Olivier; Khder, Yasser; Lehot, J.J.

doi:10.1093/bja/87.6.848

Cited by 6 publications

(3 citation statements)

References 32 publications

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“…On the other hand, Blanc P. and his colleagues in their study; concluded that no statistically important variance between placebo group and nicorandil group on cardiac enzymes release and hemodynamic variables in patients undergoing CABG surgery. The authors assumed that nicorandil, was safe for usage as a medication but there was uncertainty about its cardio protective result [24]. We agree with Blanc P. and as regard the safe use of nicorandil but there is a controverse as regard the levels of post-operative myocardial enzymes concentration.…”

Section: Discussionsupporting

confidence: 60%

Cardio-Protective Effects of Oral Nicorandil in Patients Undergoing Cardiac Valve Surgery

Ezzat¹,

Mohamed²,

Ghaffar³

et al. 2019

WJCD

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Background: Reduction of myocardial reperfusion injury during cardiopulmonary bypass is an essential requirement for increasing the success rate, decreasing morbidity and mortality of open-heart surgery. Aim: To study the role of pre-operative oral nicorandil in decreasing reperfusion cardiac injury in patients subjected to cardiac valve surgery. Patients and Methods: The study included 62 patients, who were equally randomized into two groups: nicorandil group and control group. Pre-operative, intra-operative and postoperative data were reported and analyzed. Left Ventricle Ejection Fraction (LVEF) was estimated pre-operatively and postoperatively for both groups. Troponin I, creatine kinase-muscle/brain (CK-MB), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured before surgery by 24 hours then 4, 12 and 48 hours after aortic cross clamp removal. Results: Nicorandil considerably decreased TNF-α and IL-6 after 4 and 12 hours following the removal of aortic clamping. It also reduced troponin-I and CKMB at the same time points. However, there were no important changes in IL-6, TNF-α, troponin-I and CK-MB levels in control group in comparison to nicorandil group in the next 48 hours following the removal of aortic clamping. Conclusions: Pre-operative oral nicorandil expressively decreased myocardial reperfusion damage during open heart valve operations, this evidenced by the decrease in the postoperative use of inotropic drugs, considerable reduction of postoperative elevation of cardiac enzymes and inflammatory cytokines with no reported complications.

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Section: Discussionsupporting

confidence: 60%

Cardio-Protective Effects of Oral Nicorandil in Patients Undergoing Cardiac Valve Surgery

Ezzat¹,

Mohamed²,

Ghaffar³

et al. 2019

WJCD

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“…Previous research has shown that both preoperative and intraoperative administration of NICD could have a positive impact on patient outcomes. [23][24][25] In our study, perioperative use of NICD has shown to exert a myocardial protective effect indeed. In addition, the subgroup analysis with preoperative NICD showed a new role of NICD in liver protection.…”

Section: Discussionsupporting

confidence: 58%

Effect of Perioperative Nicorandil on Myocardial Protection in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass, a Retrospective Study

Chen,

Liu,

et al. 2024

DDDT

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Background The potential myocardial protective effect of nicorandil (NICD) in patients undergoing percutaneous coronary intervention has been established. However, its efficacy in the context of cardiac surgery remains controversial. The present study aimed to evaluate the myocardial protective effect of perioperative NICD use in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods We retrospectively gathered data from patients undergoing cardiac bypass surgery between 12/2018 and 04/2021 in Fuwai Hospital. Subsequently, the patients were divided into two groups, NICD group and non-nicorandil (non-NICD) group. A 1, 3 propensity score matching (PSM) was conducted. The primary outcome was the incidence of myocardial injury. The secondary outcomes included the mechanical ventilation (MV) duration, intensive care unit (ICU) length of stay (LOS), hospital LOS, duration of chest drainage, the drainage volume, the total cost, the incidence of acute kidney injury (AKI), and the incidence of acute liver injury (ALI). Subsequently, we divided the entire population into two distinct subgroups based on their administration of NICD, and performed a comprehensive subgroup analysis. Results A total of 2406 patients were ultimately included in the study. After PSM, 250 patients in NICD group and 750 patients in non-NICD group were included in the analysis. Perioperative NICD reduced the incidence of myocardial injury (47.2% versus 38.8%, P=0.025). Our subgroup analysis revealed that preoperative NICD administration not only provided myocardial protection benefits (45.7% vs 35.8%, OR 0.66, 95% CI [0.45–0.97], P=0.041), but also demonstrated statistically significant reduction in ALI, the ICU and hospital LOS, and the duration of chest drainage (all P<0.05). Conclusion The perioperative NICD administration may confer myocardial protection in patients undergoing cardiac surgery with CPB. Furthermore, the preoperative utilization of NICD has the potential to mitigate the incidence of postoperative ALI, a reduction in the ICU and hospital LOS, and the duration of chest drainage.

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“…However, Belhomme et al failed to show a benefit [37]. Nicorandil also did not consistently prove to be useful when used during coronary bypass surgery [38,39]. None of these conditioning mimetic drugs are now being utilized routinely in conjunction with on-pump coronary bypass surgery.…”

Section: Preconditioning and Coronary Artery Bypass Surgerymentioning

confidence: 99%

Preconditioning in humans

Rezkalla

Kloner

2007

Heart Fail Rev

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Brief ischemia to the myocardium initiates a cascade of biochemical events in cardiac myocytes that protects the heart muscle during subsequent ischemic insults. This phenomenon is called ischemic preconditioning. If an acute myocardial infarction is preceded by preinfarction angina, it results in smaller infarction size, fewer cardiac arrhythmias, and better-left ventricular function. During coronary intervention, brief balloon inflation protects the heart during subsequent inflations. Patients vary in the degree of preconditioning and those patients who have the ability to demonstrate a significant preconditioning effect will have lesser incidence of subsequent cardiac events. Preconditioning protects the myocardium during coronary artery bypass surgery, particularly in the off-pump procedure, yet the thoracic surgery community has not universally adopted this technique.

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Safety of oral nicorandil before coronary artery bypass graft surgery

Cited by 6 publications

References 32 publications

Cardio-Protective Effects of Oral Nicorandil in Patients Undergoing Cardiac Valve Surgery

Cardio-Protective Effects of Oral Nicorandil in Patients Undergoing Cardiac Valve Surgery

Effect of Perioperative Nicorandil on Myocardial Protection in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass, a Retrospective Study

Preconditioning in humans

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