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

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.