Nicorandil to Prevent Contrast-Associated Kidney Injury in High-Risk PCI.
Summary
In a multicenter RCT of 585 PCI patients with renal dysfunction, oral nicorandil significantly reduced contrast-associated AKI versus hydration alone, with a dose-response favoring 10 mg TID over 5 mg TID. Findings support nicorandil as an accessible, peri-procedural renoprotective strategy.
Key Findings
- Randomized 585 high-risk PCI patients to high-dose nicorandil, conventional-dose, or hydration-only control.
- CA-AKI incidence was 19.8% in control vs 10.9% (conventional) and 8.7% (high-dose), indicating a dose-response benefit.
- Secondary biomarker assessments (creatinine, BUN, cystatin C, CRP) were prespecified; primary endpoint reduction drove overall benefit.
Clinical Implications
Consider peri-procedural oral nicorandil (10 mg TID) as an adjunct to hydration for PCI patients with renal dysfunction to lower CA-AKI risk; integrate into cath lab protocols while awaiting long-term outcome data.
Why It Matters
Demonstrates a simple, low-cost, dose-dependent intervention that reduces CA-AKI in a common high-risk PCI population, with immediate practice implications.
Limitations
- Blinding status and adjudication details not reported in abstract
- Long-term renal and cardiovascular outcomes not assessed
Future Directions
Confirm findings in diverse health systems, assess long-term renal and clinical outcomes, and compare nicorandil with other nephroprotective strategies.
Study Information
- Study Type
- RCT
- Research Domain
- Prevention
- Evidence Level
- I - Multicenter randomized controlled trial with clinically relevant outcomes
- Study Design
- OTHER