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Nicorandil in preventing contrast-induced nephropathy in patients undergoing cardiac catheterization procedures: a
Ramsha Waseem1, Ajay Kumar1, Simran Kumari2
1Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
Insights
Nicorandil significantly reduces contrast-induced nephropathy (CIN) risk in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). This drug also improves key kidney function markers post-procedure.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Contrast-induced nephropathy (CIN) is a significant risk for patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI).
- Identifying effective preventative strategies for CIN is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of nicorandil in preventing CIN in patients undergoing CAG or PCI.
- To assess nicorandil's impact on renal function biomarkers.
Main Methods:
- A systematic literature search identified 11 RCTs and 1 prospective cohort study (2910 patients).
- Meta-analysis pooled data to assess CIN incidence and changes in serum creatinine, cystatin C, BUN, and eGFR.
- Random-effects models were used to calculate risk ratios and standardized mean differences.
Main Results:
- Nicorandil significantly reduced CIN incidence (RR: 0.40, P < 0.00001) with both oral and IV formulations.
- Patients receiving nicorandil showed significantly lower serum creatinine and cystatin C levels post-procedure.
- No significant effect of nicorandil on estimated glomerular filtration rate (eGFR) was observed at 24, 48, or 72 hours.
Conclusions:
- Nicorandil administration effectively reduces CIN incidence and improves renal biomarker profiles in patients undergoing CAG and PCI.
- Further large-scale clinical trials are warranted to confirm the renoprotective benefits of nicorandil.
Background:
Contrast-induced nephropathy (CIN) remains a significant complication in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI).
Methods:
A comprehensive literature search was conducted across PubMed, MEDLINE, Embase, Google Scholar, and Web of Science up to May 2024 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of nicorandil in patients undergoing CAG or PCI. The primary outcome was CIN incidence, while secondary outcomes included, changes in serum creatinine, serum cystatin C, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). Risk ratios (RRs) and standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I2 statistic.
Results:
Eleven RCTs and one prospective cohort study involving 2910 patients were included. Nicorandil administration was associated with a significant reduction in CIN incidence (RR: 0.40 [0.31-0.52], P < 0.00001), with both oral (RR: 0.35 [0.25-0.48], P < 0.00001) and intravenous formulations (RR: 0.52 [0.30-0.92], P = 0.02) demonstrating efficacy (p-interaction = 0.22). Patients receiving nicorandil exhibited significantly lower serum creatinine levels at 48 hours (SMD: -0.34 [-0.52, -0.16], P = 0.0002) and 72 hours (SMD: -0.24 [-0.40, -0.08], P = 0.003) post-procedure. Serum cystatin C was also significantly reduced at 48 hours (SMD: -0.48 [-0.81, -0.15], P = 0.004). However, nicorandil did not produce a significant change in eGFR at 24 hours (SMD: 0.17 [-0.07, 0.41], P = 0.17), 48 hours (SMD: 0.13 [-0.10, 0.37], P = 0.26), or 72 hours (SMD: 0.19 [-0.07, 0.45], P = 0.36).
Conclusion:
Nicorandil administration reduces CIN incidence and improves renal biomarker profiles in patients undergoing CAG and PCI. Further large-scale trials are necessary to validate its renoprotective properties.
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