Efficacy Of Intravenous Nicorandil On The Prevention Of Contrast-induced Nephropathy In Elderly Patients With Coronary Heart Disease Undergoing Percutaneous Coronary Intervention In Perioperative Period

Purposes:This study was to investigate the preventive effect of intravenous nicorandil on CIN in elderly patients with coronary heart disease after PCI.Method:400 consecutive elderly patients of coronary heart disease who underwent elective PCI from January 2019 to June 2019 were selected in the three Departments of Cardiology in Tianjin Chest Hospital.The patients were randomly divided into control group(n = 200)and nicorandil group(n = 200).Patients in the nicorandil group received 24 mg of nicorandil injection intravenously every day before PCI and3 days after PCI on the basis of hydration treatment.(Drug configuration method: 12 mg nicorandil injection + 50 ml of normal saline,continuously intravenous injection twice per day at 4 mg / h);patients in the control group only received hydration treatment.Blood specimens were collected before PCI and at 48 and 72 hours after contrast administration to measure blood urea nitrogen,blood creatinine,cystatin C and creatinine clearance.The indexes of inflammatory and oxidative indexes were measured at admission and 24 hours after the use of contrast medium,including the levels of high-sensitivity C-reactiveprotein,blood uric acid and blood homocysteine.The incidence of CIN and major adverse events were observed.The primary endpoint was the incidence of contrast-induced nephropathy,defined as rise in serum creatinine ≥44.2 μmol/L or >25% above baseline within 72 hours after exposure to contrast administered during percutaneous coronary intervention.Secondary endpoints included differences in post-percutaneous coronary intervention serum creatinine,blood urea nitrogen,creatinine clearance rate,cystatin-C,high-sensitivity C-reactiveprotein,blood uric acid and blood homocysteine at 24,48 and 72 h after PCI and occurrence of major adverse events during hospitalization and 14 days postoperative follow-up.Result:1.The CIN occurred in 7 patients in the nicorandil group and 20 patients in the control group.The results showed that the incidence of CIN in the nicorandil group was significantly lower than control group,and the difference was statistically significant(3.5% VS.10.0%,P = 0.010).2.There was no significant difference in the blood urea nitrogen,creatinine,cystatin C,and creatinine clearance rate between the nicorandil group and the control group before PCI operation(P>0.05).At 48 and 72 hours after contrast administration,blood urea nitrogen,creatinine,cystatin C levels were significantly lower and creatinine clearance rate were significantly higher with nicroandil therapy compared to conventional treatment(P <0.05).3.The baseline levels of high-sensitivity C-reactiveprotein,blood uric acid and blood homocysteine were not statistically significant in the two groups of patients(P>0.05).The levels of high-sensitivity C-reactiveprotein,blood uric acid and blood homocysteine in all patients were higher than pre-exposure baseline,and the high-sensitivity C-reactive protein,blood uric acid,and blood homocysteine in the nicorandil group was significantly lower than the control group.The difference was statistically significant(P <0.05).4.In the univariate logistic regression results,the predictive factors of CIN were preoperative LVEF,contrast agent dose,preoperative creatinine,diabetes,and nicorandil treatment.According to multivariate logistic regression analysis,nicorandil treatment is a protective factor of CIN.Independent predictors of CIN development included contrast agent dose,preoperative creatinine,and diabetes.5.Subgroup analysis showed that nicorandil significantly reduced the incidence of CIN at age <70 years,male,baseline LVEF> 45%,no diabetes,stable angina pectoris,baseline e GFR 60-89 ml / min / 1.73m~2.By contrast,the influence of trimetazidine was abated in subgroups of aged ≥70 years,females,LVEF≤45%,diabetes,acute coronary syndrome and baseline≥90ml / min / 1.73m~2 and <60ml / min/ 1.73m~2.Conclusion:Intravenous nicorandil in elderly patients with coronary heart disease can reduce the incidence of CIN after PCI in perioperative period.The mechanism may be that intravenous nicorandil can inhibit the oxidative stress and vascular inflammation.