Nicorandil for prevention of contrast-induced nephropathy in patients undergoing coronary angiography: a meta-analysis.

INTRODUCTION

Contrast-induced nephropathy (CIN) is a feared complication of angiographic procedures, resulting in a sudden decline in renal function.

METHODS

PubMed, ScienceDirect, and Google Scholar were searched for potentially relevant articles from inception till August 2024. The meta-analysis was conducted using RevMan 5.4 with risk ratios (RR), mean differences (MD), and 95% confidence intervals (95% CI) computed.

RESULTS

Ultimately, 13 studies were incorporated in the analysis. Nicorandil portrayed a significant protective effect against CIN (RR: 0.42; 95% CI: 0.33-0.54; p < 0.00001). Subgroup analysis revealed the superiority of the oral administration (RR: 0.38; 95% CI: 0.28-0.50; p < 0.00001). Nicorandil was also effective in reducing CIN in renal dysfunction patients (RR: 0.40; 95% CI: 0.27-0.59; p < 0.00001). Blood urea nitrogen (BUN) and cystatin-C 48-hours post-procedure (MD: -0.42; 95% CI: -0.53--0.30; p < 0.00001 and MD: -0.27; 95% CI: -0.51--0.02; p = 0.03, respectively) were superior in the nicorandil cohort. Serum creatinine was significantly lower in patients receiving nicorandil at 24- and 72-hour intervals (MD: -3.18, MD: -4.26, and MD: -3.75, respectively). There were no increased risks of adverse events in the nicorandil cohort.

CONCLUSION

Nicorandil has promising efficacy and safety in reducing the risk of CIN. However, further trials are necessary in order to validate our conclusions.