Preventive Effect Of Nicorandil On Contrast Induced Nephropathy:A Systematic Review And Meta-analysis

Background:As the number of patients with coronary heart disease increases year by year,coronary interventional therapy is one of the most important means of clinical treatment of coronary heart disease.In recent years,nicorandil as an anti-angina drug has been widely used in the field of coronary heart disease drug treatment.At the same time,nicorandil can resist oxidative stress,reduce renal ischemia-reperfusion injury,and protect the kidneys.However,there are currently different opinions on the safety and effectiveness of nicorandil in the prevention of contrast nephropathy in clinical practice.In this paper,the effectiveness of nicorandil in the prevention of contrast nephropathy is analyzed by means of a meta-analysis,hoping to provide some evidence-based evidence for clinical drug use.Methods:The comprehensive search includes all randomized controlled trials included in Pub Med,Web of science,Clinical trails,Wanfang Database,CNKI,VIP Chinese scientific journals,and China Biomedical Literature Database(CBM).The search time is set from the establishment of the database to 2021.October.Two research scholars independently searched Chinese and English databases,and screened,extracted and evaluated the literature.The modified Jadad score was used to evaluate the quality of the included literature,and the I2statistic was used to test for heterogeneity.Fixed or random effects were selected.Model.Statistical analysis was performed using Revman 5.3 software.Results:Six studies were included in the study,with a total of 1394 patients,695 in the experimental group and 699 in the control group.The incidence of CIN in the experimental group was 4.9%,and the incidence of CIN in the control group was11.9%.Statistical analysis data showed that the difference in the incidence of CIN between the experimental group and the control group was statistically significant,and nicorandil combined with hydration could significantly reduce the incidence of CIN[I~2=0%,P=0.47,RR=0.41,95%CI(0.28,0.60),P<0.00001].At the same time,the effect of nicorandil on postoperative renal function was compared.Compared with the control group,the 48-hour serum creatinine[MD=-9.32,95%CI(-16.68,-1.95),P=0.01],72 Hourly serum creatinine[MD=-5.10,95%CI(-8.10,-2.10),P=0.0009],48-hour serum cystatin C[MD=-0.22,95%CI(-0.38,0.07),P=0.005]and72 h serum cystatin C[MD=-0.22,95%CI(-0.43,-0.02),P=0.04]were significantly lower than those in the control group,and the difference was statistically significant.Conclusion:1.Nicorandil has a preventive effect on the occurrence of CIN after coronary intervention,which can reduce the incidence of CIN.2.Nicorandil can reduce the increase of Scr and Cysc after surgery,suggesting that it may have a protective effect on renal function after coronary intervention.3.Nicorandil had no significant effect on the incidence of renal replacement therapy and all-cause mortality.