Raymond Pranata1, Rachel Vania2, Amir Aziz Alkatiri3, Doni Firman3, Antonia Anna Lukito4. 1. Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia. Electronic address: raymond_pranata@hotmail.com. 2. Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia. 3. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. 4. Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village, Tangerang, Indonesia. Electronic address: Antonia.lukito@uph.edu.
Abstract
BACKGROUND: Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of nicorandil on the incidence of CIN in patients undergoing CAG/PCI. METHODS: We performed a comprehensive search on topics that assessed nicorandil and CIN in CAG/PCI patients from inception up until November 2019 through several electronic databases. RESULTS: There were a total of 1532 subjects from 7 randomized controlled trials. Nicorandil was associated with decrease CIN incidence (OR 0.31 [0.20, 0.46], p < 0.001; I2: 0%). Funnel plot was asymmetrical, indicating the risk of publication bias. Oral administration (OR 0.29 [0.18, 0.46], p < 0.001; I2: 0%) has a greater efficacy compared to intravenous route (OR 0.40 [0.17, 0.93], p < 0.001; I2: 73%). Pooled analysis of adjusted OR revealed that nicorandil reduced CIN incidence independent to other factors in the respective studies (OR 0.34 [0.16, 0.74], p = 0.006, I2: 75%). Protection against CIN (OR 0.37 [0.22, 0.61], p < 0.001; I2: 22%) was also demonstrated in renal dysfunction subgroup, pooled adjusted OR showed that the effect is independent (OR 0.30 [0.10, 0.90], p = 0.03, I2: 86%). GRADE assessment showed moderate level of certainty for the CIN reducing effect of nicorandil in both unadjusted and adjusted models with an absolute reduction of 85 per 1000 and 87 per 1000. Harbord test showed no evidence of small-study effects (p = 0.866). CONCLUSION: Nicorandil is associated with a lower risk of CIN in patients undergoing CAG/PCI with a moderate level of certainty.
BACKGROUND: Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of nicorandil on the incidence of CIN in patients undergoing CAG/PCI. METHODS: We performed a comprehensive search on topics that assessed nicorandil and CIN in CAG/PCI patients from inception up until November 2019 through several electronic databases. RESULTS: There were a total of 1532 subjects from 7 randomized controlled trials. Nicorandil was associated with decrease CIN incidence (OR 0.31 [0.20, 0.46], p < 0.001; I2: 0%). Funnel plot was asymmetrical, indicating the risk of publication bias. Oral administration (OR 0.29 [0.18, 0.46], p < 0.001; I2: 0%) has a greater efficacy compared to intravenous route (OR 0.40 [0.17, 0.93], p < 0.001; I2: 73%). Pooled analysis of adjusted OR revealed that nicorandil reduced CIN incidence independent to other factors in the respective studies (OR 0.34 [0.16, 0.74], p = 0.006, I2: 75%). Protection against CIN (OR 0.37 [0.22, 0.61], p < 0.001; I2: 22%) was also demonstrated in renal dysfunction subgroup, pooled adjusted OR showed that the effect is independent (OR 0.30 [0.10, 0.90], p = 0.03, I2: 86%). GRADE assessment showed moderate level of certainty for the CIN reducing effect of nicorandil in both unadjusted and adjusted models with an absolute reduction of 85 per 1000 and 87 per 1000. Harbord test showed no evidence of small-study effects (p = 0.866). CONCLUSION:Nicorandil is associated with a lower risk of CIN in patients undergoing CAG/PCI with a moderate level of certainty.
Authors: Mangiring P L Toruan; Raymond Pranata; Budi Yuli Setianto; Sofia Mubarika Haryana Journal: Biomed Res Int Date: 2020-05-21 Impact factor: 3.411