Abstract 12180: Effectiveness of Nicorandil, a K-ATP Channel Opener, Against Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients with Poor Renal Function
Background: Contrast-induced nephropathy (CIN) has become a significant source of hospital morbidity and mortality due to the ever-increasing use of iodinated contrast media with percutaneous coronary intervention (PCI) in patients with poor renal function. This led us to reconsider the effect of cardioprotective agents on the kidney. Current best practice calls for intravenous periprocedural volume expansion in at-risk patients, but no pharmacological approach has yet been shown to offer consistent protection. Nicorandil, a K-ATP channel opener and NO donor, is used to treat angina pectoris and has a pharmacologic preconditioning effect. We therefore conducted a prospective randomized trial to assess the protective effect of Nicorandil against CIN after PCI in patients with poor renal function.
Methods and Results: We enrolled 164 patients (average age: 69.9+/−8 yrs, mean+/−SD) who would subsequently undergo PCI and who had a high cystatin C level. These patients were randomly divided into 2 groups: the saline group (n=81) and the Nicorandil group (n=83, 0.096 mg/ml Nicorandil infused at 1ml/kg/hr for 4 hrs prior to PCI). There were no significant differences in baseline characteristics, including contrast medium volume, between the 2 groups. However, the average percent rise in serum creatinine (ΔsCr%) was significantly smaller in the Nicorandil group than the saline group, 2 days and 1 month after PCI (-1.81% vs. 0.16% after 2 days, and 0.02% vs. 6.21% after 1 month, p<0.01). Likewise, the average percent rise in the stimulated glomerular filtration rate (eGFR) were significantly larger in the Nicorandil group than the saline group (3.0% vs. 1.5% after 2 days, and 2.1% vs. -3.5% after 1 month, p<0.05). The incidences of major adverse cardiovascular and renal events during the month after PCI were also lower in the Nicorandil group than the saline group (7.2% vs. 21.0%). In particular, the incidence of CIN was dramatically lower in the Nicorandil group than the saline group (1.2% vs. 8.6%, p<0.05). These results suggest that Nicorandil have favorable renoprotective effects against CIN, as well as cardioprotective effects after PCI.
Conclusions: Nicorandil strongly prevents CIN and improves prognosis in patients with poor renal function undergoing PCI.
- © 2011 by American Heart Association, Inc.