Protective Effection Of Nicorandil On Contrast-induced Acute Kidney Injury During Primary PCI

Objective:The incidence of contrast-induced acute kidney injury?CONTRAST INDUCED ACUTE KIDNEY INJURY,CIAKI?is increasing,which increases the dialysis rate and mortality of patients,which seriously affects the prognosis.Nicorandil is an ATP-sensitive potassium channel opener with diastolic blood vessels,reducing oxygen free radical damage,and antagonizing ischemia-reperfusion injury.It has been widely used in patients with acute myocardial infarction.Some studies have reported that perioperative combined with nicorandil during perioperative coronary percutaneous coronary intervention?PCI?can reduce the incidence of postoperative CIAKI.The aim of this study was to investigate whether nicorandil can reduce the incidence of CIAKI after primary PCI in patients with acute ST-segment elevation myocardial infarction?STEMI??Method:Inclusion of STEMI patients who underwent primary PCI at the Second Affiliated Hospital of Nanchang University from October 1,2017 to February 28,2019,Inclusion of patients has excluded basic renal insufficiency or long-term hemodialysis,cardiogenic shock,hypotension,postoperative salvage hydration,history of contrast exposure on the 7th day before surgery,and Severe incompleteness of clinical data,etc.Sex,age,history of hypertension,history of diabetes,smoking history,Killip classification,myocardial infarction,and catheterization data?preoperative TIMI classification,number of diseased vessels,amount of contrast agent?,hemoglobin,albumin were collected,total cholesterol,low-density lipoprotein cholesterol,BNP,statins/ACEI/ARB applications,admission and postoperative 24h/48h/72h/5-7d serum creatinine,eGFR,uric acid,?₂-microglobulin,postoperative Patient CK-MB peak were collected.Study step one:According to whether nicorandil was given after surgery,patients were divided into nicorandil group?72 mg nicorandil intravenously within 12 hours after surgery?and the control group.According to CIAKI diagnostic criteria:as a 25%increase in baseline SCr concentration or an absolute increase of0.5 mg/dl?44.2?mol/l?after contrast-media administration.The incidence of CIAKI and the postoperative CK-MB peak were compared between the two groups.Renal function changes at 24h/48h/72h/5-7d after surgery were compared between the two groups.Study step two:All patients were divided into CIAKI group and non-CIAKI group according to whether CIAKI occurred or not,the differences among the baseline data were compared.Univariate analysis and multivariate regression were used to find CIAKI risk factors.All data were statistically analyzed by SPSS 24.0software,P<0.05 was statistically significant.Result:1.The study included 156 STEMI patients who underwent primary PCI,including128 males?82%?and 28 females?18%?with an average age of 61.53±13.13 years.Of the 156 patients,55 were in the nicorandil group?male/female=45/10,mean age61.20±11.90 years?,and 101 patients in the control group?male/female=83/18,mean age 61.71±13.81 years?.2.The incidence of CIAKI in the nicorandil group was 12.7%,the incidence of CIAKI in the control group was 26.7%,and the chi-square test P=0.043.There was a significant difference in the incidence of CIAKI between the two groups.3.Comparison between the two groups:blood creatinine?81.82±18.23 vs 94.26±30.25,P=0.002?and uricacid?372.90±119.69 vs 423.51±118.06,P=0.012?,?₂-microglobulin in the nicorandil group on 48h after operation?2.05±0.63 vs 2.41±1.52,P=0.037?were lower than the control group,and eGFR was improved?89.70±21.67 vs77.83±21.56,P=0.001?.At 72h after surgery,creatinine?82.04±18.83 vs 94.31±32.38,P=0.008?,uric acid?365.53±104.16 vs 427.95±133.16,P=0.003?,?₂-microglobulin?2.11±0.76 vs2?.75±1.36,P=0.001)was lower than the control group,and eGFR was improved?88.62±21.73vs76.84±22.27,P=0.005?.Serum creatinine?81.43+17.46 vs90.33+22.20,P=0.023?,uric acid?373.90+105.39 vs 420.05+125.79,P=0.029?and?₂-microglobulin?2.08+0.95 vs 2.64+1.12,P=0.015?in nicorandil group were lower than those in control group on 5-7 days after operation.The eGFR was improved?91.21+22.44 vs 81.12+21.33,P=0.032?.The postoperative CK-MB peak was lower in the nicorandil group by[105.30?56.61,232.04?vs 178.00?77.08,271.91?,P=0.042].4.CIAKI group?n=34,mean age 63.87±11.96 years?hypertension?67.6%vs 39.3%,P=0.003?,diabetes ratio?41.2%vs 20.5%,P=0.014?were higher than non-CIAKI The group?n=122,mean age 60.58±13.33 years?,the proportion of nicorandil treatment?20.6%vs 39.3%,P=0.043?was lower than that of the non-CIAKI group.Univariate analysis showed that the history of hypertension??=0.214,P=0.007?and diabetes history??=0.208,P=0.019?were positively correlated with the incidence of CIAKI,and nicorandil treatment??=-0.168,P=0.032?is negatively correlated with the incidence of CIAKI.Bivariate logistic regression showed that history of hypertension and diabetes were independent risk factors for CIAKI[OR=2.711,95%CI?1.315⁵.589?],[OR=2.885,95%CI?1.290⁶.452?].Treatment with nicorandil was an independent risk factor for CIAKI[OR=0.372,95%CI?0.165⁰.838?]were protective factors.Conclusion:1.Intravenous nicorandil has protective effect on CIAKI in STEMI patients after primary PCI.2.History of hypertension and diabetes mellitus are risk factors for CIAKI in STEMI patients after primary PCI.