The protective effects of Nicorandil on renal function in patients undergoing coronary interventions: a systematic review and meta-analysis.

BACKGROUND: Contrast-induced nephropathy (CIN) is a serious complication in patients undergoing cardiac interventions, especially in patients with chronic kidney disease. This study aims to assess the efficacy of Nicorandil in CIN reduction and its impact on renal function outcomes. METHODS: A comprehensive search was conducted from inception to September, 2024 across four databases. Randomized controlled trials (RCTs) assessing the efficacy of Nicorandil for patients undergoing coronary procedures were included. RESULTS: Based on analysis of 11 clinical trials involving 2837 patients, Nicorandil significantly reduced the incidence of CIN compared to control group (RR = 0.37, 95%CI [0.27 to 0.49], P < 0.001) without heterogeneity. Nicorandil group was superior to control group in reducing the rise in serum creatinine level at 24, 48 and 72 h (MD= -4.45 umol/L, 95%CI [-7.94 to -0.97], P = 0.01), (MD= -5.57 umol/L, 95%CI [-8.95 to -2.20], P < 0.001) and (MD= -5.70 umol/L, 95%CI [-9.57 to -1.82], P = 0.004) respectively. However, there was no statistically significant difference between Nicorandil group and control group regarding estimated glomerular filtration rate (eGFR) measured at 24, 48 and 72 h (MD = 2.17, 95%CI [-2.03 to 6.37], P = 0.31), (MD = 1.89, 95%CI [-0.15 to 3.93], P = 0.17) and (MD = 2.26, 95%CI [-0.37 to 4.89], P = 0.09) respectively. Nicorandil showed no statistically significant difference between both groups regarding any major adverse event, including stroke, myocardial infarction, conversion to emergency Percutaneous Coronary Intervention (PCI), or urgent need for dialysis. CONCLUSION: Nicorandil had an effective role in reducing the incidence of CIN, lower rise in creatinine, and a good safety profile in patients undergoing coronary interventions. CLINICAL TRIAL NUMBER: Not applicable.