Nicorandil to Prevent Contrast-Associated Kidney Injury in High-Risk PCI

BACKGROUND: Patients with renal dysfunction remain at high risk for contrast-associated acute kidney injury despite standard peri-procedural volume administration. This study aims to investigate whether peri-procedural oral nicorandil provides additional protection in this population, and to evaluate its potential dose-response relationship. METHODS: We conducted a prospective, multicenter, randomized controlled trial enrolling patients with percutaneous coronary intervention with renal dysfunction. Participants were randomized into 3 groups, including a high-dose nicorandil group (30 mg/d, 10 mg 3× daily), a conventional-dose nicorandil group (15 mg/d, 5 mg 3× daily), and a saline hydration-only control group. The primary end point was the incidence of contrast-associated acute kidney injury. Secondary end points included changes in serum creatinine, blood urea nitrogen, CysC (cystatin C), and CRP (C-reactive protein). This represented a relative risk reduction of 50% and 61% for the conventional- and high-dose groups, respectively. CONCLUSIONS: Adjunctive nicorandil, particularly at a dose of 10 mg 3× daily, significantly reduced the incidence of contrast-associated acute kidney injury in percutaneous coronary intervention patients with renal dysfunction. Oral nicorandil represents a readily available, effective, and dose-dependent prophylactic strategy to enhance renoprotection. Future studies are warranted to evaluate the long-term clinical benefits of this intervention. REGISTRATION: URL: https://www.chictr.org.cn; Unique identifier: CTR2200064264.