Prevention effects of nicorandil on contrast-induced nephropathy after coronary angiography or stent implantation ： a meta-analysis / 中国药房

ABSTRACT

OBJECTIVE To syste matically evaluate the prevention effects of nicorandil on contrast-induced nephropathy in patients underwent coronary angiography （CAG）or stent implantation （CSI），and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed ，Embase，Cochrane library ，Wanfang database ，CBM and CNKI ，randomized controlled trial （RCT）about nicorandil （trial group ）versus normal saline or placebo （control group ）prevented contrast-induced nephropathy in patients underwent CAG or CSI were collected during the inception to Nov. 2021. After extracting literature that met the inclusion criteria ，the bias risk assessment tool of RCT in Cochrane manual was used for quality evaluation ，and meta-analysis was performed by using RevMan 5.3 software. RESULTS A total of 17 RCTs were included ，involving 3 279 patients. Among them，there were 1 587 patients in trial group ，and 1 692 patients in control group. Results of meta-analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lo wer than control group [RR ＝0.40，95％CI（0.31，0.51）， P＜0.000 1] . Results of subgroup analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lower than control group ，whether intravenous administration [RR ＝0.47，95％CI（0.29，0.74），P＝0.001] or oral administration [RR ＝0.37，95％CI（0.28，0.50），P＜0.000 01]，whether patients with normal renal function [RR ＝0.42，95％CI（0.30， 0.59），P＜0.000 01] or with renal insufficiency [RR ＝0.38， 95％ CI（0.26，0.54），P＜0.000 01]. Scr of 24 h[SMD＝ －1.38，95％CI（－2.32，－0.44），P＝0.004]，48 h[SMD＝ －0.81，95％CI（－1.19，－0.43），P＜0.000 1] and 72 h[SMD＝ －0.24，95％CI（－0.43，－0.05），P＝0.01] after surgery in trialgroup were significantly lower than control group ；the 163.com decrease of creatinine clearance rate of 48 h[SMD＝1.27， 95％CI（0.48，2.07），P＝0.001] and 72 h[SMD＝0.37，95％CI（0.07，0.67），P＝0.02] after surgery in trial group were significantly lower than control group ；cystatin C of 24 h[SMD＝－0.93，95％CI（－1.72，－0.14），P＝0.02]，48 h[SMD＝－1.72，95％CI （－2.33，－1.10），P＜0.000 01] and 72 h[SMD＝－0.36，95％CI（－0.62，－0.10），P＝0.006] after surgery in trial group were significantly lower than control group. CONCLUSIONS Pretreatment of nicorandil can reduce the incidence of contrast-induced nephropathy in patients underwent CAG or CSI ，and reduce the damage of renal function after application of contrast.