| Background:With the increased life level and elevated living pace, the mortality and morbidity of coronary heart diseases tend to increase every year. Nicorandil, with dual pharmacological effects of adenosine triphosphate sensitive potassium channel opener (K-ATP channel opener) and nitrate, has been largely used for the treatment of coronary heart diseases. The 3-year IONA study reported that nicorandil significantly reduced the incidence of unplanned hospital admission for cardiac chest pain to improve the prognosis, but it had no effect on severe clinical results like coronary heart disease death and non-fatal myocardial infarction. Furthermore, although some studies of nicorandil treatment for unstable angina, acute myocardial infarction or heart failure also reported that nicorandil could reduce major adverse cardiac events (MACE), but for single outcome like cardiac deaths or unstable angina, their results were not the same, and even conflicting. Therefore, it is necessary to do some research on the exact effect of nicorandil on long-term prognosis of patients with coronary heart diseases.Methods:Publications about nicorandil treatment of coronary heart diseases were identified up to April 2010 by means of a computer search of pubmed, medline, proquest (ARL) and cochrane library databases. Two reviewers checked randomized prospective cohort or retrospective cohort clinical trials, and extracted data regarding patient and disease characteristics, study design and clinical outcomes of interest.Results:Five clinical trials were included for this meta-analysis. The analysis of outcomes, as well as the test for heterogeneity and publication bias, was carried out by using Review Manager statistical software. Nicorandil treatment reduced the incidence of major adverse cardiac events (P=0.001, OR=0.42,95%CI:0.25 to 0.70), for which the occurrence of cardiac deaths(P=0.003, OR=0.40,95%CI:0.22 to 0.74), unplanned hospital admission for cardiac chest pain(P<0.0001, OR=0.68,95%CI: 0.57 to 0.81) and congestive heart failure (P=0.02, OR=0.70,95%CI:0.52 to 0.95) were significantly reduced compared with the control group. There was no statistical significance for the occurrences of non-fatal myocardial infarction (P=0.62), unstable angina(P=0.10), TIA or stroke(P=0.73)between these two groups. At the same time, nicorandil significantly reduced all-cause deaths due to the decrease of cardiovascular deaths, but no beneficial effect was observed on the non-cardiovascular deaths.Conclusions:Nicorandil treatment improved long-term prognosis of patients with coronary heart diseases by significantly reducing the incidence of cardiac deaths, unplanned hospital admission for cardiac chest pain and congestive heart failure. This added something new to the drug treatment of coronary heart diseases. Therefore, additional use of nicorandil based on standard medications for coronary heart diseases may be beneficial for patients. Background:It remains a question that whether nicorandil would have long-term cardioprotective effects on patients with coronary heart diseases (CHD). A meta-analysis was performed to study the impact of nicorandil on the prognosis of patients with CHD.Methods:Publications about nicorandil treatment of CHD were identified up to April 2010 by means of a computer search of pubmed, proquest (ARL) and cochrane library databases. Two reviewers checked randomized prospective cohort or retrospective cohort clinical trials, and extracted data regarding patient and disease characteristics, study design and clinical outcomes of interest.Results:Five clinical trials were included for this meta-analysis. The analysis of outcomes, as well as the test for heterogeneity and publication bias, was carried out by using Review Manager statistical software. Nicorandil treatment reduced the incidence of major adverse cardiac events (P=0.001, OR=0.42,95%CI:0.25 to 0.70), for which the occurrence of cardiac deaths(P=0.003, OR=0.40,95%CI:0.22 to 0.74), unplanned hospital admission for cardiac chest pain(P<0.0001, OR=0.68,95%CI: 0.57 to 0.81) and congestive heart failure (P=0.02, OR=0.70,95%CI:0.52 to 0.95) were significantly reduced compared with the control group. There was no statistical significance for the occurrences of non-fatal myocardial infarction (P=0.62), unstable angina(P=0.10), TIA or stroke(P=0.73)between these two groups. At the same time, nicorandil significantly reduced all-cause deaths due to the decrease of cardiovascular deaths, but no beneficial effect was observed on the non-cardiovascular deaths.Conclusions:This meta-analysis demonstrated that nicorandil treatment could improve prognosis of patients with CHD. |
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