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Effect of Perioperative Nicorandil on Myocardial Protection in Patients Undergoing Cardiac Surgery with
Yuye Chen1, Yue Liu2, Hong Lv1
1Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences&Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, 100037, People's Republic of China.
Insights
Perioperative nicorandil (NICD) use may protect the heart during cardiac surgery with cardiopulmonary bypass. Preoperative NICD specifically reduced myocardial injury, liver injury, and hospital stay.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Nicorandil (NICD) has established myocardial protective effects in percutaneous coronary intervention.
- Its role in cardiac surgery remains debated.
- This study investigates perioperative NICD in cardiac surgery with cardiopulmonary bypass (CPB).
Purpose of the Study:
- To evaluate the myocardial protective effect of perioperative nicorandil (NICD) administration.
- To assess NICD's impact on myocardial injury and other clinical outcomes in cardiac surgery patients.
- To explore subgroup effects of preoperative NICD administration.
Main Methods:
- Retrospective study of 2406 cardiac bypass surgery patients (12/2018-04/2021).
- Propensity score matching (PSM) created NICD (250) and non-NICD (750) groups.
- Primary outcome: myocardial injury; secondary outcomes: ventilation duration, ICU/hospital LOS, drainage, costs, AKI, ALI.
Main Results:
- Perioperative NICD reduced myocardial injury incidence (47.2% vs 38.8%, P=0.025).
- Preoperative NICD showed myocardial protection (45.7% vs 35.8%, P=0.041).
- Preoperative NICD significantly reduced ALI, ICU/hospital LOS, and chest drainage duration (P<0.05).
Conclusions:
- Perioperative nicorandil (NICD) may offer myocardial protection during cardiac surgery with CPB.
- Preoperative NICD use shows potential to decrease postoperative acute liver injury (ALI), shorten ICU and hospital length of stay (LOS), and reduce chest drainage duration.
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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