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Decreased cardiac mortality with nicorandil in patients with ischemic heart failure
Akiomi Yoshihisa1, Yu Sato2, Shunsuke Watanabe2
1Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan. yoshihis@fmu.ac.jp.
Insights
Nicorandil may reduce cardiac mortality in patients with ischemic heart failure. This study found lower cardiac death rates in patients taking nicorandil compared to those who were not.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Effective treatments for ischemic heart failure (HF) remain under investigation.
- Nicorandil, a vasodilator and potassium channel opener, is used for angina.
- Its impact on cardiac mortality in ischemic HF requires further study.
Purpose of the Study:
- To evaluate the effect of nicorandil on cardiac mortality in patients with ischemic heart failure.
- To determine if nicorandil administration is associated with reduced cardiac death rates.
Main Methods:
- Retrospective analysis of 334 ischemic heart failure patients.
- Patients were divided into nicorandil (n=116) and non-nicorandil (n=218) groups.
- Cardiac mortality was assessed using Kaplan-Meier and Cox proportional hazard analyses.
Main Results:
- Cardiac mortality was significantly lower in the nicorandil group (11.2%) versus the non-nicorandil group (19.7%).
- Nicorandil use was associated with a reduced risk of cardiac mortality (HR 0.512, P=0.035).
- This benefit was consistent across various subgroups, including those with different ejection fractions and comorbidities.
Conclusions:
- Nicorandil shows potential as an effective treatment for reducing mortality in ischemic heart failure.
- Further prospective studies are warranted to confirm these findings.
Background:
Effective treatments in heart failure (HF) patients with ischemic etiology have not been fully established. Nicorandil, combination of nitrate component and sarcolemmal adenosine triphosphate-sensitive potassium channel opener, is a potent vasodilator of coronary and peripheral vessels and has been used as an antianginal agent. Therefore, we examined impacts of nicorandil on cardiac mortality in ischemic HF patients.
Methods:
Consecutive 334 HF patients with ischemic etiology were retrospectively registered and divided into 2 groups based on oral administration of nicorandil: nicorandil group (n = 116) and non-nicorandil group (n = 218). We retrospectively examined cardiac mortality.
Results:
In the Kaplan-Meier analysis (mean follow-up period 963 days), cardiac mortality was significantly lower in the nicorandil group than in the non-nicorandil group (11.2% vs. 19.7%, P = 0.032). In the Cox proportional hazard analysis, usage of nicorandil was a suppressor of cardiac mortality (hazard ratio 0.512, 95% confidence interval 0.275-0.953, P = 0.035), and this result was consistent in several subgroup analyses, such as left ventricular ejection fraction, percutaneous coronary intervention, coronary artery bypass graft, diabetes, β-blockers, and statins.
Conclusion:
Nicorandil is potentially effective for reducing mortality in patients with ischemic heart failure.
Trial Registration:
This was a retrospective study.
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