Key result
Nicorandil did not significantly reduce the overall incidence of perioperative complications (RR 0.91) or levels of myocardial injury markers in patients with angina pectoris undergoing elective PCI.
Why the study?
Nicorandil was believed to improve perioperative myocardial injury during PCI, but recent studies showed no improvement in functional and clinical outcomes in elective PCI for angina pectoris.
Does nicorandil reduce perioperative myocardial injury and MACE in patients with angina pectoris undergoing elective PCI?
Meta-Analysis (n=979)
Does nicorandil reduce perioperative myocardial injury and MACE in patients with angina pectoris undergoing elective PCI?
Relative Risk: 0.91 (95% CI 0.46–1.81)
In patients with angina undergoing elective PCI, nicorandil does not reduce perioperative myocardial injury or MACE, but may improve coronary flow.
No significant MACE reduction with nicorandil; leaves open its role in cardioprotection pending larger trials.
AIMS: Nicorandil, which is a mitochondrial ATP-sensitive potassium channel opener, is believed to improve perioperative myocardial injury (PMI) in patients undergoing percutaneous coronary intervention (PCI), but recent studies have shown that nicorandil treatment did not improve functional and clinical outcomes in patients with angina pectoris who underwent elective PCI. We performed a meta-analysis to investigate the protective effect of nicorandil on perioperative injury in patients with angina pectoris who underwent elective PCI. METHODS: The Medline, EMBASE, and Cochrane databases were searched for randomized clinical trials examining the effects of nicorandil. Two investigators independently selected suitable trials, extracted data, and assessed trial quality. RESULTS: Seven studies of patients undergoing elective PCI, comprising a total of 979 patients, were included in this review. The results showed that nicorandil did not reduce the levels of markers of myocardial injury (standardized mean difference [SMD] 0.31 [95%CI -0.6, 1.22] for creatine kinase-MB [CK-MB] and 1.29 [95%CI -2.18, 4.76] for troponin I [TNI]), perioperative complications (relative risk [RR] 0.91 [95%CI 0.46-1.81]), target vessel revascularization (RR 0.79 [95%CI 0.50-1.25]) or major adverse cardiac events (MACE) (RR 0.83 [95%CI 0.49-1.43]). Nicorandil did reduce the corrected TIMI frame count (SMD-0.30 [95%CI -0.52, -0.09]). CONCLUSION: Although nicorandil did not reduce the overall incidence of perioperative complications and the incidence of major adverse cardiac events (MACE) in patients with angina pectoris who underwent elective PCI, it could still improve no reflow and slow coronary flow.
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Zhu et al. (2019) conducted a meta-analysis in Angina pectoris undergoing elective percutaneous coronary intervention (n=979). Nicorandil vs. Placebo was evaluated on Perioperative complications (RR 0.91, 95% CI 0.46-1.81). Nicorandil did not significantly reduce the overall incidence of perioperative complications (RR 0.91) or levels of myocardial injury markers in patients with angina pectoris undergoing elective PCI.
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