Department of Cardiothoracic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Extracorporeal Circulation, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
Angiology. 2020 Aug;71(7):609-615. doi: 10.1177/0003319720919327. Epub 2020 Apr 15.
The clinical outcomes of nicorandil in percutaneous coronary intervention (PCI) are conflicting. We sought to evaluate the effects of nicorandil on periprocedural myocardial injury (PMI) in elective PCI. Eligible studies that reported the effect of nicorandil on PMI in elective PCI were obtained from PubMed, Web of Science, and Cochrane Library (up to October 28, 2019). The outcomes were PMI and major adverse cardiovascular and cerebrovascular events (MACCEs). Ten randomized controlled trials with 1304 patients undergoing elective PCI were evaluated. Nicorandil significantly reduced the incidence of PMI (odds ratio [OR] = 0.48; = .0003); however, there was no significant difference in MACCEs (OR = 0.80; = .45) between the 2 groups. Subgroup analyses showed that nicorandil significantly lowered the PMI risk when only patients with stable coronary artery disease (OR = 0.41; = .0008) were considered and when nicorandil was administered intravenously (OR = 0.41; = .0007) or orally (OR = 0.33; = .0001). This meta-analysis suggests that nicorandil could reduce the incidence of PMI without increasing the occurrence of MACCEs in elective PCI. The effect of nicorandil in lowering the PMI risk is associated with the diagnosis of the patients and the route of nicorandil administration.
尼可地尔在经皮冠状动脉介入治疗（PCI）中的临床结局存在争议。我们旨在评估尼可地尔对选择性 PCI 围手术期心肌损伤（PMI）的影响。从 PubMed、Web of Science 和 Cochrane Library（截至 2019 年 10 月 28 日）中获取了报告尼可地尔对选择性 PCI 中 PMI 影响的合格研究。结局指标为 PMI 和主要不良心血管和脑血管事件（MACCEs）。评估了 10 项随机对照试验，共纳入 1304 例接受选择性 PCI 的患者。尼可地尔显著降低了 PMI 的发生率（比值比 [OR] = 0.48； =.0003）；然而，两组间 MACCEs（OR = 0.80； =.45）无显著差异。亚组分析表明，当仅考虑稳定型冠状动脉疾病患者（OR = 0.41； =.0008）或给予尼可地尔静脉内（OR = 0.41； =.0007）或口服（OR = 0.33； =.0001）时，尼可地尔可显著降低 PMI 风险。这项荟萃分析表明，尼可地尔可降低选择性 PCI 中 PMI 的发生率，而不会增加 MACCEs 的发生。尼可地尔降低 PMI 风险的效果与患者的诊断和尼可地尔给药途径有关。
