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
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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><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>Nicorandil administration reduces the CIN incidence and improves renal biomarkers in patients undergoing CAG and PCI. 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引用次数: 0
摘要
背景：造影剂肾病（CIN）是接受冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）的患者的主要风险。方法：截至2024年5月，检索PubMed、MEDLINE、Embase、谷歌Scholar和Web of Science，纳入评估尼可地尔在CAG或PCI患者中的疗效和安全性的随机对照试验（rct）。结果包括CIN发生率、主要不良事件、血清肌酐、血清胱抑素C、BUN和eGFR。采用随机效应模型计算风险比（rr）和95%置信区间（ci）的标准均值差（SMDs）。采用I2统计量评估统计异质性。结果：12项研究（n = 2931例）纳入最终分析。尼可地尔显著降低CIN发生率(RR: 0.40 [0.31,0.52]；结论：尼可地尔可降低CAG和PCI患者的CIN发生率，改善肾脏生物标志物。为了证实尼可地尔的肾保护作用，有必要进行长期随访的大规模试验。
Role of nicorandil in preventing contrast-induced nephropathy in patients undergoing cardiac catheterization procedures: an updated systematic review and meta-analysis.
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.
期刊介绍：
International Urology and Nephrology publishes original papers on a broad range of topics in urology, nephrology and andrology. The journal integrates papers originating from clinical practice.
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