Preventive Effect Of Pretreatment With Nicorandil And Isoosmolar Contrast Media On Contrast-Induced Nephropathy In Patients Undergoing Coronary Angiography

Objective: To investigate the effect of pretreatment with nicorandil and isoosmolar contrast mediaon on the incidence of contrast-induced nephropathy(CIN)in patients undergoing coronary angiography(CAG).Methods:This study particularly collect baseline clinical characteristics of eligible patients,including gender,age,weight,blood routine test,hepatic function,blood creatinine,cystatin C,β2-microglobulin,glomerular filtration rate(GFR),creatinine clearance(Ccr),Hypertension,Diabetes Melitus,basic drugs and Mehran scores.According to the use of nicorandil and isoosmolar contrast media,we divided those erolled patients into four groups randomly:group A(conventional treatment without nicorandil but ioversol in processs,n=22);group B(conventional treatment without nicorandil but iodixanol in processs,n=18);group C(conventional treatment with nicorandil and ioversol in processs,n=21);group D(conventional treatment with nicorandil and iodixanol in processs,n=19).Inclusion criteria:(1)above 18 years of age;(2)Patients’ family members have signed CAG informed consent;(3)patients with diabetes melitus have to stop the use of biguanide drugs before the process.Exclusion criteria:(1)LVEF<30%with severe heart failue;(2)Severe hepatic or renal insufficiency;(3)Allergic to Iodinated contrast;(4)Iodinated contrast in 7 days;(5)Renal transplantion,Single kidney or required dialysis treatment;(6)nicorandil contraindication;(7)With severe Infected;(8)The presence of autoimmune and hematological diseases;(9)The disorders of coagulation function;(10)Patients with tumors.Conventional treatment included aspririn,clopidogrel,statins,β-blockers,ACEI/ARB,isosorbide mononitrate and calcium channel blocker;The difference was the use ofnicorandil(5mg TID)in group C and group D,which was continued more than three days after the process.All groups have the same hydration scheme before and after the process.Observation index: The results of creatinine,cystatin C and β2microglobulin before the process and after the process 24 hours and 48 hours were recorded.The incidence of the primary end-point event CIN.Statistical methods:All the data were analyzed by SPSS21.0,there is significant difference when P < 0.05.Result:Among 80 cases in this study,22 were randomly assigned to group A(16male,average age 57.91±6.63 years old),18 to group B(14 male,average age60.94±13.20 years old),21 to group C(16 male,average age 57.71±9.21 years old)and 19 to group D(13 male,average age 63.26±9.02 years old).1 Comparison about baseline clinical characteristics.There were no significant differences between the four groups in baseline characteristics,including age,gender,weight,hematocrit,hemoglobin,serum creatinine,cystatin C and β2 microglobulin,glomerular filtration rate(GFR),Mehran scores were analyzed by F test,the results are all P>0.05,no significant differences and the count data including hypertension,diabetes,smoking history and drinking history,and basic drugs including aspirin,clopidogrel,β-blockers,ACEI/ARB,statins and calcium channel blocker,were analyzed by chi square test,all P>0.05,no statistical significance.2 Comparison of the incidence of contrast-induced nephropathy(CIN)The primary end-point was the incidence of CIN,defined as >0.5 mg/dL increase or >25% rise in serum creatinine(SCr)concentration within 48 hours of contrast exposure com-pared to baseline.There was one case of CIN in each group:groupA(4.5%),groupB(5.6%),groupC(4.8%),groupD(5.3%).Comparison with two groups,the,No significant difference was found concerning the incidence of CIN(P=0.999>0.05).3 Comparison of the cystatin C and β2 microglobulinAcorrding to analysis those data,we find that :(1)About the cystatin C,variation among groups F=3.599,P=0.017<0.05;variation within groups P>0.05;(2)About the β2 microglobulin,variation among groups F=3.276,P=0.026<0.05;variation within groups P>0.05.So we can conclud that the factors of grouping have effect on both cystatin C and β2microglobulin.Conclusion:There were no obvious preventive effect of nicorandil and isoosmolar contrast media on the incidence of contrast-induced nephropathy(CIN)in patients undergoing coronary angiography;While the combination may protect the early renal function in some ways.