Comparison Of The Protective Effect Of Trimetazidine And Nicorandil On Renal Function In Patients Undergoing Percutaneous Coronary Intervention

BackgroundContrast-induced nephropathy(CIN)is a major complication of intravascular injection of iodine-containing contrast media during medical examination or treatment,and it is one of the common causes of hospital-acquired acute renal failure.CIN together with in-stent restenosis and in-stent thrombosis have become major long-term complications of percutaneous coronary intervention(PCI).It can increase the in-hospital mortality and is associated with adverse outcomes.The pathophysiology of CIN has not been fully clarified till today and the possible mechanisms include:(1)contrast media(CM)induced vasoconstriction and reduction in renal blood flow which results in renal ischemic injury and increased generation of reactive oxygen radicals;(2)Tubular epithelium damage caused by CM directly.Due to there is still no effective treatment for CIN,preventative measurements should be adopted before CM exposure.Hydration is the most commonly used prevention at present.Trimetazidine(TMZ)can enhance the glucose oxidation and optimize the process of cellular energy metabolism.Nicorandil has the effect of dilating coronary arteries,relieving coronary vasospasm and increasing coronary blood flow.It was observed in animal models that nicorandil can also dilate small arteries in the kidneys.Previous researches have shown that TMZ and nicorandil can reduce the incidence of CIN in patients undergoing PCI.However,there are neither TMZ and nicorandil head-to-head studies nor studies to evaluate the efficacy of the combination of the two medicines on CIN.Also,candidates recruited in previous studies were with renal insufficient(estimated glomerular filtration rate,eGFR<60ml/min/1.73m2),whether the two medicine can exert similar protective effect in patients with normal renal function still needs further investigation.Purpose(1)To evaluate the protective effect of TMZ and nicorandil on renal function in patients undergoing elective PCI with eGFR>60 ml/min/1.7 m2;(2)To compare the protective effect of TMZ and nicorandil and evaluate the efficacy of the combination of the two medicines.MethodAccording to the inclusion criteria,161 patients scheduled for PCI with eGFR>60ml/min/1.73m2 were enrolled into this study.The candidates were divided into control group,trimetazidine group,nicorandil group,trimetazidine plus nicorandil group.Both TMZ and nicorandil were administered orally 72 hours before and 48 hours after the procedure.All patients in the four groups were given intravenous saline(0.9%)at a rate of 1 ml/kg/h 6 hours before and 12 hours after the procedure.Serum creatinine(SCr),GFR were measured before,48 and 72 hours after the procedure to evaluate the renal function.An absolute increase of 44 ?mol/L(0.5mg/dL)in SCr or a relative increase of 25%than baseline levels at 48 to 72 hours after intravascular CM administration was diagnosed as CINResults(1)The baseline characteristics of patients in the four groups were similar;(2)Comparing with baseline levels,SCr increased and eGFR decreased significantly in control group,TMZ group,nicorandil group and TMZ plus nicorandil group at 48 hours after the procedure,all P values<0.05;(3)The increment of SCr at 48 hours after PCI in control group(?Scr=18.63±9.21?mol/L)is higher than TMZ group(?Scr?1.10±5.62 ?mol/L)and nicorandil group(?Scr=9.23±5.60 ?mol/L);TMZ plus nicorandil group had the lowest increment of SCr(AScr=2.23±1.42?mol/L),all P values<0.001.The difference between TMZ group and nicorandil group was not significant,P>0.05;(4)SCr and eGFR returned to baseline levels in TMZ group,nicorandil group and TMZ plus nicorandil group at 72 hours after the procedure(P>0.05).However,SCr was still higher and eGFR was still lower than baseline levels in control group(P<0.05);(5)Contrast-induced nephropathy developed in 14.6%(6/41)in control group,2.5%(1/40)in TMZ group and 2.5%(1/40)in nicorandil group(P<0.05),none in TMZ plus nicorandil group.TMZ group,nicorandil group and TMZ plus nicorandil group had significant lower CIN incidence compared to control group,P<0.05.Conclusions(1)TMZ and nicorandil can significantly decrease SCr level and lower risk of CIN after PCI compared with hydration treatment alone;(2)The efficacy of TMZ and nicorandil on renal protection and lowering CIN risks was similar;(3)The efficacy of TMZ combined with nicorandil on renal protection and lowering CIN risks was greater than TMZ or nicorandil used alone.