Nicorandil in preventing contrast-induced nephropathy in patients undergoing cardiac catheterization procedures: a systematic review and meta-analysis

Background: Contrast-induced nephropathy (CIN) remains a significant complication in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). Methods: A comprehensive literature search was conducted across PubMed, MEDLINE, Embase, Google Scholar, and Web of Science up to May 2024 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of nicorandil in patients undergoing CAG or PCI. The primary outcome was CIN incidence, while secondary outcomes included, changes in serum creatinine, serum cystatin C, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). Risk ratios (RRs) and standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I2 statistic. Results: Eleven RCTs and one prospective cohort study involving 2910 patients were included. Nicorandil administration was associated with a significant reduction in CIN incidence (RR: 0.40 [0.31–0.52], P < 0.00001), with both oral (RR: 0.35 [0.25–0.48], P < 0.00001) and intravenous formulations (RR: 0.52 [0.30–0.92], P = 0.02) demonstrating efficacy (p-interaction = 0.22). Patients receiving nicorandil exhibited significantly lower serum creatinine levels at 48 hours (SMD: −0.34 [–0.52, −0.16], P = 0.0002) and 72 hours (SMD: −0.24 [–0.40, −0.08], P = 0.003) post-procedure. Serum cystatin C was also significantly reduced at 48 hours (SMD: −0.48 [–0.81, −0.15], P = 0.004). However, nicorandil did not produce a significant change in eGFR at 24 hours (SMD: 0.17 [–0.07, 0.41], P = 0.17), 48 hours (SMD: 0.13 [–0.10, 0.37], P = 0.26), or 72 hours (SMD: 0.19 [–0.07, 0.45], P = 0.36). Conclusion: Nicorandil administration reduces CIN incidence and improves renal biomarker profiles in patients undergoing CAG and PCI. Further large-scale trials are necessary to validate its renoprotective properties.