Nicorandil May Reduce the Risk for Contrast-Induced Nephropathy After Elective PCI

Nicorandil may safely lower the risk for contrast-induced nephropathy (CIN) following elective percutaneous coronary intervention (PCI), according to a study published in the Journal of Interventional Cardiology.

Investigators conducted a pooled analysis of 6 randomized controlled trials (n=1229 adults) in which the effect of nicorandil vs placebo on the incidence of CIN was examined in patients ages ≥18 years treated with elective PCI. Nicorandil is an adenosine triphosphate-sensitive potassium channel “opener” with a nitrate ester compound. The study’s primary outcome was the incidence of CIN, and the secondary outcomes was the occurrence of major adverse events, including mortality, heart failure, recurrent myocardial infarction, stroke, and renal replacement therapy.

Nicorandil was found to lower the risk for CIN (odds ratio [OR], 0.26; 95% CI, 0.16-0.44; P <.00001). The secondary outcome was comparable in patients treated with nicorandil vs placebo (P >.05).

Nicorandil was found to reduce the incidence of CIN when administered orally (3 trials; n=618; OR, 0.25; 95% CI, 0.13-0.47; P <.0001) or intravenously (3 trials; n=611; OR, 0.28; 95% CI, 0.12-0.66; P =.004).

Study limitations include the definition of CIN used, which was based on changes in serum creatinine and may not capture early renal impairment, insufficient data to examine various doses of nicorandil, and the sole inclusion of Asian participants.

“Because of the small sample size and the deficient information of the enrolled patients, the conclusions should be further validated in future well-designed, large-scale, clinical trials,” noted the investigators.

Reference

Yi B, Mo S, Jiang Y, et al. Efficacy and safety of nicorandil in preventing contrast-induced nephropathy after elective percutaneous coronary intervention: A pooled analysis of 1229 patients. J Interv Cardiol. 2020;2020:4527816.