Efficacy and safety of nicorandil for prevention of contrast-induced nephropathy in patients undergoing coronary procedures: a systematic review and meta-analysis
Document Type
Article
Publication Title
International urology and nephrology
Abstract
BACKGROUND: Contrast-induced nephropathy (CIN) is a potentially serious complication of intravenous or intra-arterial contrast administration during angiographic procedures that results in renal dysfunction. CIN can increase the risk of mortality by three-fold. This meta-analysis assesses the efficacy and safety of nicorandil for the prevention of CIN in patients undergoing percutaneous coronary intervention (PCI) or coronary angiography (CAG). METHODS: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov were used to perform a thorough literature search from their inception to July 2024. Twelve randomized controlled trials (RCTs) were included. A random-effects meta-analysis was performed on RevMan and pooled estimates were presented as forest plots. The Mantel-Haenszel method was used for dichotomous outcomes and risk ratios (RRs) were calculated along with 95% confidence intervals (95% CI). RESULTS: This meta-analysis included 2787 participants (nicorandil: 1418, control: 1394). The use of nicorandil was protective against CIN (RR 0.38, 95% CI 0.29-0.50). There was no significant difference in major adverse events between the groups (RR 0.77, 95% CI 0.52-1.13, p = 0.18). Similarly, the use of nicorandil did not affect the risk of developing stroke (RR 1.05, 95% CI: 0.38-2.95), myocardial infarction (RR 0.90, 95% CI: 0.56-1.43), heart failure (RR 0.81, 95% CI: 0.39-1.68), cardiac death (RR 0.90, 95% CI: 0.28-2.88) and dialysis (RR 0.70, 95% CI: 0.11-4.44). CONCLUSION: This meta-analysis concludes that nicorandil reduces CIN incidence after PCI or CAG without significantly increasing major adverse events. However, further well-designed, large-scale RCTs are needed to strengthen the practical relevance before routine clinical use.
First Page
2181
Last Page
2194
DOI
10.1007/s11255-025-04409-1
Publication Date
7-1-2025
Recommended Citation
Butt, Ayesha Imran; Afzal, Fazila; Raza, Sukaina; Namal, F N.; Ahmed, Dawood; Abid, Hassaan; Hudaib, Muhammad; Sarwar, Zainab Safdar; Bashir, Soha; Khalid, Asadullah; Hassan, Umer; Rehman, Mohammad Ebad; Cheema, Huzaifa Ahmad; Husnain, Ali; Anwar, Usama; Tahir, Muhammad Mohid; Ahmad, Adeel; Rehman, Wajeeh Ur; and Ahmed, Raheel, "Efficacy and safety of nicorandil for prevention of contrast-induced nephropathy in patients undergoing coronary procedures: a systematic review and meta-analysis" (2025). Radiology. 129.
https://scholar.bridgeporthospital.org/radiology/129
Identifier
39937383 (pubmed); 10.1007/s11255-025-04409-1 (doi); 10.1007/s11255-025-04409-1 (pii)