Efficacy and Safety of Nicorandil in Acute Coronary Syndrome: A Meta-Analysis

Background Nicorandil acts as a potassium channel opener, however its cardio protective benefit is still uncertain. This meta-analysis was conducted with the objective of evaluating the efficacy of nicorandil in improving cardiovascular outcomes in acute coronary syndrome. Main Body A total of 24 RCTs with 1640 patients in the nicorandil group and 1592 patients in the control group were identified following PRISMA guidelines till November 2019 and were matched for inclusion and exclusion criteria. The following search strings and MESH terms were used: “nicorandil”, “ACS”, “MACE”. Following this, nicorandil was evaluated for its efficacy and safety outcomes. RevMan 5.3 was used for appropriate statistical tests. Fixed and Random Effect Model Test were used and p<0.05 was considered statistically significant. Results Administration of nicorandil was found to be associated with a significant decrease in MACE (RR = 0.686, 95% CI = 0.509-0.925, p=0.013), no-reflow phenomenon (RR =0.395, 95% CI = 0.266-0.588, p<0.001) and worsening of HF (RR =0.441, 95% CI = 0.221-0.882, p=0.021). It was also associated with significant improvement in LVEF (SMD= 0.637, 95% CI= 0.0972 to 1.177, p=0.021) and significant lowering of cTFC (SMD= -0.216, 95% CI= -0.428 to -0.0041, p=0.046) Conclusions Nicorandil does indeed exert a cardio protective effect by improving cardiovascular outcomes. There is a significant decrease in occurrences of MACE and worsening of HF. There is also significant improvement in LVEF.