Efficacy and Safety of Nicorandil for Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Procedures: A Systematic Review and Meta-Analysis

Ayesha Imran Butt, Fazila Afzal, Sukaina Raza, FNU Namal, Dawood Ahmed, Hassaan Abid, Muhammad Hudaib, Zainab Safdar Ali Sarwar, Soha Bashir, Asadullah Khalid, Umer Hassan, Mohammad Ebad Ur Rehman, Huzaifa Ahmad Cheema, Ali Husnain, Usama Anwar, Muhammad Mohid Tahir, Adeel Ahmad, Wajeeh Ur Rehman, Raheel Ahmed
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Abstract

Abstract Background: Contrast-induced nephropathy (CIN) is a potentially serious complication of intravenous or intra-arterial contrast administration during angiographic procedures that results in renal dysfunction. This meta-analysis assesses the efficacy and safety of nicorandil for the prevention of CIN in patients undergoing percutaneous coronary intervention (PCI) or coronary angiography (CAG). Methods: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov were used to perform a thorough literature search from their inception to July 2024. A random-effects meta-analysis was performed on RevMan and pooled estimates were presented as forest plots. The Mantel-Haenszel method was used for dichotomous outcomes and risk ratios (RRs) were calculated along with 95% confidence intervals (95% CI). Results: This meta-analysis included 12 RCTs consisting of 2787 participants (nicorandil: 1418, control: 1394). The use of nicorandil was protective against CIN (RR 0.38, 95% CI 0.29-0.50). The incidence of major adverse events was comparable in both groups (RR 0.77, 95% CI 0.52-1.13, p=0.18). Similarly, the use of nicorandil did not affect the risk of developing stroke (RR 1.05), myocardial infarction (RR 0.90), heart failure (RR 0.81), cardiac death (RR 0.90), and dialysis (RR 0.70). Conclusion: This study revealed that nicorandil effectively reduced the risk of developing CIN in patients undergoing angiographic procedures like PCI or coronary angiography. However, more RCTs should be conducted for a more definitive conclusion.
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尼可地尔预防冠状动脉手术患者对比度诱发肾病的有效性和安全性:系统回顾与元分析
摘要背景:造影剂诱发肾病(CIN)是血管造影术中静脉或动脉内注射造影剂可能导致肾功能障碍的一种严重并发症。本荟萃分析评估了尼可地尔对经皮冠状动脉介入治疗(PCI)或冠状动脉造影术(CAG)患者预防 CIN 的有效性和安全性:方法:使用 Cochrane Central Register of Controlled Trials、MEDLINE、Embase 和 ClinicalTrials.gov 对从开始到 2024 年 7 月的文献进行了全面检索。在RevMan上进行了随机效应荟萃分析,并以森林图的形式展示了汇总的估计值。对二分结果采用曼特尔-海恩泽尔法,并计算风险比(RR)和95%置信区间(95% CI):这项荟萃分析包括 12 项 RCT,共有 2787 名参与者(尼可地尔:1418 人,对照组:1394 人)。使用尼可地尔对 CIN 有保护作用(RR 0.38,95% CI 0.29-0.50)。两组的主要不良事件发生率相当(RR 0.77,95% CI 0.52-1.13,P=0.18)。同样,使用尼可地尔不会影响中风(RR 1.05)、心肌梗死(RR 0.90)、心力衰竭(RR 0.81)、心源性死亡(RR 0.90)和透析(RR 0.70)的发病风险:本研究显示,尼可地尔能有效降低接受 PCI 或冠状动脉造影等血管造影术的患者罹患 CIN 的风险。然而,要得出更明确的结论,还需要进行更多的 RCT 研究。
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