The Effects Of Nicorandil Combine With Trimetazidine On Contrast-induced Nephrophathy Undergoing Elective Percutaneous Coronary Intervention

Background:Percutaneous coronary intervention(PCI)is an effective method for the treatment of coronary heart disease.With the increasing application of percutaneous coronary intervention,contrast-induced nephropathy is an important cause of hospital-acquired injury at present,but there is no effective CIN treatment.Therefore,how to prevent CIN has become an important research content.In clinic,there are many reports about the preventive effect of nicorandil or trimetazidine on CIN in foreign countries,but there is no report about the control or combined application of the two drugs on the prevention of CIN.To observe the effects of intravenous nicorandil and/or oral trimetazidine on CIN and serum creatinine,and to evaluate the synergistic effect of the two drugs on prevention of CIN after PCI.Objective: The aim of this research was to study the effects of Nicorandil combined with Trimetazidine on Contrast-Induced Nephrophathy Undergoing Elective Percutaneous Coronary Intervention(PCI).Methods: 521 patients of acute coronary syndrome with elective PCI were random divide into 4 groups in total.The control group(group A,n=208),nicorandil group(group B,n=105),trimetazidine group(group C,n=104),nicorandil plus trimetazidine group(group D,n=104),The control group received hydration and aspirin,?-blockers,statins and other conventional drugs for coronary heart disease.The other three groups were given their medication on the basis of the above treatment at 48 hours prior to PCI.The levels of correlative blood index were measured and conmpared in four groups at before and 72 hours postoperation.Results: There were no significant differences in age,gender,e GFR,c-reactive protein,serum creatinine,MPV,urea nitrogen and other indicators between the groups before surgery,and no statistical significance was found.Serum creatinine,urea nitrogen,c-reactive protein and MPV were increased and e GFR was decreased on day 3 after PCI compared with that before PCI(all P groups<0.05).The differences of serum creatinine,urea nitrogen,c-reactive protein,e GFR,MPV and preoperative values between group D and group A on the third day after PCI were significantly reduced(all P<0.05).Drug interaction analysis showed that both nicodil and trimetazidine could effectively reduce the difference between creatinine and preoperative creatinine on the third day after PCI(P value was 0.010 and 0.001,respectively).There was an interaction between the two drugs and the difference between creatinine before and after PCI,and the combined use was better than the single use.In addition,the incidence of CIN in each group was lower than that in group A,and the difference between group D and group A was statistically significant(P=0.009).There was no significant difference in the incidence of adverse events between the four groups(P>0.05).Multivariate Logistic regression showed that nicodil combined with trimetazidine(OR =0.114,95%ci 0.015-0.880,P =0.037)was an independent factor for CIN I protection after adjusting for age,sex,systolic blood pressure,hematocrit,basal creatinine value,diabetes mellitus,contrast agent volume and Mehran score.Conclusion: Taking trimetazidine or nicorandil may reduced the incidence of CIN,moreover,the combined effect was more obvious,but there was no significant difference in renal protection between the two groups.The mechanism may be associated with anti-inflammatory effects.