Related Experiment Video
Updated: Aug 20, 2026
Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration
Published on: April 4, 2022
Aims:
IONA (impact of nicorandil in angina) is a randomised, double blind, placebo controlled trial of nicorandil, with a target dose of 20 mg twice daily. The consistency of benefits seen in subgroups is reported.
Methods:
The primary composite end point of the study was coronary heart disease death, non-fatal myocardial infarction, or unplanned hospitalisation for cardiac chest pain. Subgroups were defined using baseline characteristics including, age, sex, histories of smoking, diabetes, hypertension, myocardial infarction, revascularisation, anginal status, anti-anginal treatment, other cardiovascular drugs, and an overall assessment of risk.
Results:
A total of 5126 patients were randomised to receive nicorandil or identical placebo in addition to standard anti-anginal treatment. Overall, nicorandil reduced the incidence of the primary end point from 15.5% to 13.1% (hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.72 to 0.97; p = 0.014). There was no evidence of significant heterogeneity of benefit across all subgroups studied. The absolute risk reduction was greatest and the numbers needed to treat to prevent one event was lowest in subjects at greatest risk.
Conclusions:
The IONA study demonstrates a significant improvement in outcome by nicorandil treatment across a broad range of patients with stable angina.
Insights
Nicorandil significantly reduces adverse cardiovascular events in patients with stable angina. The drug demonstrated consistent benefits across diverse patient subgroups, particularly those at higher risk.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Stable angina remains a significant cause of morbidity and mortality.
- Effective anti-anginal treatments are crucial for improving patient outcomes.
- The Impact of Nicorandil in Angina (IONA) trial investigated nicorandil's efficacy.
Purpose of the Study:
- To evaluate the overall effectiveness of nicorandil in patients with stable angina.
- To assess the consistency of nicorandil's benefits across various patient subgroups.
- To determine the impact of nicorandil on major adverse cardiovascular events.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 5126 patients.
- Patients received either nicorandil (20 mg twice daily) or placebo, in addition to standard anti-anginal therapy.
- Primary endpoint: composite of coronary heart disease death, non-fatal myocardial infarction, or unplanned cardiac chest pain hospitalization.
Main Results:
- Nicorandil reduced the primary endpoint incidence from 15.5% to 13.1% (HR 0.83, p=0.014).
- No significant heterogeneity of benefit was observed across all studied subgroups.
- Greatest absolute risk reduction and lowest number needed to treat were seen in high-risk patients.
Conclusions:
- Nicorandil treatment significantly improves outcomes in a broad range of patients with stable angina.
- The benefits of nicorandil are consistent across diverse patient populations.
- Nicorandil is an effective therapeutic option for managing stable angina.
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