Efficacy and safety of nicorandil for prevention of contrast-induced nephropathy in patients undergoing coronary procedures: a systematic review and meta-analysis.

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. CIN can increase the risk of mortality by three-fold. 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. Twelve randomized controlled trials (RCTs) were included. 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 2787 participants (nicorandil: 1418, control: 1394). The use of nicorandil was protective against CIN (RR 0.38, 95% CI 0.29-0.50). There was no significant difference in major adverse events between the 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, 95% CI: 0.38-2.95), myocardial infarction (RR 0.90, 95% CI: 0.56-1.43), heart failure (RR 0.81, 95% CI: 0.39-1.68), cardiac death (RR 0.90, 95% CI: 0.28-2.88) and dialysis (RR 0.70, 95% CI: 0.11-4.44).

CONCLUSION

This meta-analysis concludes that nicorandil reduces CIN incidence after PCI or CAG without significantly increasing major adverse events. However, further well-designed, large-scale RCTs are needed to strengthen the practical relevance before routine clinical use.