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Background <p>Contrast-induced nephropathy (CIN) is a major risk for patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI).</p> Methods <p>PubMed, MEDLINE, Embase, Google Scholar, and Web of Science were searched through May 2024 to include randomized controlled trials (RCTs) assessing the efficacy and safety of nicorandil administration in patients following CAG or PCI. Outcomes of interest included the CIN incidence, major adverse events, serum creatinine, serum cystatin C, BUN and eGFR. Risk ratios (RRs) and standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects model. Statistical heterogeneity was assessed using I2 statistics.</p> Results <p>Twelve studies (n = 2931 patients) were included in the final analysis. Nicorandil significantly reduced the CIN incidence (RR: 0.40 [0.31,0.52]; p &lt; 0.00001), with consistent results for oral (RR: 0.35 [0.25,0.48]; p &lt; 0.00001) and intravenous administration (RR: 0.52 [0.30,0.92]; p = 0.02) (p-interaction = 0.22). Oral nicorandil reduced the risk of major adverse events (RR: 0.71 [0.51,0.99]; p = 0.05). Among patients on nicorandil, serum creatinine levels were significantly lower at 48&#xa0;h (SMD: −0.30 [−0.52,−0.07]; p = 0.009), and 72&#xa0;h post-intervention (SMD: −0.42 [−0.71,−0.13]; p = 0.004). Nicorandil significantly reduced serum cystatin C levels at 48&#xa0;h post-intervention (SMD: -0.56 [−1.01,−0.01]; p = 0.02). However, nicorandil did not significantly affect eGFR values at 24-h (SMD: 0.12 [−0.21,0.45]; p = 0.46), 48-h (SMD: 0.08 [−0.19,0.35]; p = 0.58), and 72-h (SMD: 0.34 [−0.13,0.81]; p = 0.16).</p> Conclusion <p>Nicorandil administration reduces the CIN incidence and improves renal biomarkers in patients undergoing CAG and PCI. Large-scale trials with longer follow-up periods are warranted to confirm renoprotective effects of nicorandil.</p>

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Role of nicorandil in preventing contrast-induced nephropathy in patients undergoing cardiac catheterization procedures: an updated systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年5月4日

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  • Ahmed Ali Khan,
  • Muhammad Zubair Tahir,
  • Kanz Ul Eman Maryam,
  • Muhammad Uzair,
  • Haram,
  • Muhammad Shaheer Bin Faheem,
  • Zainab,
  • Amna Abdullah,
  • Ahmed Anwer,
  • Danish Ali Ashraf,
  • Amna Kaleem Ahmed,
  • Sidrah Rahim,
  • Muhammad Sameer Arshad

摘要

Background

Contrast-induced nephropathy (CIN) is a major risk for patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI).

Methods

PubMed, MEDLINE, Embase, Google Scholar, and Web of Science were searched through May 2024 to include randomized controlled trials (RCTs) assessing the efficacy and safety of nicorandil administration in patients following CAG or PCI. Outcomes of interest included the CIN incidence, major adverse events, serum creatinine, serum cystatin C, BUN and eGFR. Risk ratios (RRs) and standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects model. Statistical heterogeneity was assessed using I2 statistics.

Results

Twelve studies (n = 2931 patients) were included in the final analysis. Nicorandil significantly reduced the CIN incidence (RR: 0.40 [0.31,0.52]; p < 0.00001), with consistent results for oral (RR: 0.35 [0.25,0.48]; p < 0.00001) and intravenous administration (RR: 0.52 [0.30,0.92]; p = 0.02) (p-interaction = 0.22). Oral nicorandil reduced the risk of major adverse events (RR: 0.71 [0.51,0.99]; p = 0.05). Among patients on nicorandil, serum creatinine levels were significantly lower at 48 h (SMD: −0.30 [−0.52,−0.07]; p = 0.009), and 72 h post-intervention (SMD: −0.42 [−0.71,−0.13]; p = 0.004). Nicorandil significantly reduced serum cystatin C levels at 48 h post-intervention (SMD: -0.56 [−1.01,−0.01]; p = 0.02). However, nicorandil did not significantly affect eGFR values at 24-h (SMD: 0.12 [−0.21,0.45]; p = 0.46), 48-h (SMD: 0.08 [−0.19,0.35]; p = 0.58), and 72-h (SMD: 0.34 [−0.13,0.81]; p = 0.16).

Conclusion

Nicorandil administration reduces the CIN incidence and improves renal biomarkers in patients undergoing CAG and PCI. Large-scale trials with longer follow-up periods are warranted to confirm renoprotective effects of nicorandil.