Nicorandil, an opener of the adenosine triphosphate-sensitive potassium channel and a dilator of coronary vasculature, might help patients avoid contrast-induced nephropathy (CIN).
Yiming Zhang, MD, of Affiliated Hospital of Jining Medical College in China, and colleagues conducted a meta-analysis of 4 randomized controlled trials of 709 Asian patients undergoing coronary angiography or percutaneous coronary intervention with contrast media. Included trials were judged of moderate quality.
Periprocedural nicorandil significantly reduced CIN risk by 62% compared with controls, according to results published online in Cardiovascular Therapeutics. How nicorandil was administered mattered. In subgroup analysis, oral nicorandil significantly reduced CIN risk by 68%, whereas intravenous (IV) nicorandil did not decrease CIN risk.
Nicorandil also was associated with a significant 4% lower increment in serum creatinine from baseline after 48 hours from contrast administration compared with controls. Nicorandil was not significantly associated with changes in cystatin C.
The nicorandil dose was 10 mg thrice daily or 10 mg once daily for the oral formation and 12 mg or 96 mg for the IV formulation. The volume of contrast dye varied from 125 to 215 mL, but was comparable between treated and untreated groups in each trial. Control groups received normal saline, placebo, or no treatment. All patients received pre-procedural hydration.
“In conclusion, results of our meta-analysis showed that periprocedural treatment with nicorandil may be preventative against the incidence of CIN in patients undergoing contrast exposure,” Dr Zhang and his team stated. “The influence of periprocedural nicorandil on the clinical outcome in these patients deserves further investigation.”
Ma X, Li X, Jiao Z, and Zhang Y. Nicorandil for the prevention of contrast-induced nephropathy: a meta-analysis of randomized controlled trials. Cardio Therap. doi: 10.1111/1755-5922.12316