Nicorandil: What is Beyond the Anti-Anginal Action?

Mohamed Shehata*

Nicorandil: What is Beyond the Anti-Anginal Action?

Incidence of Contrast Induced Nephropathy (CIN) among ischemic heart disease patients subjected to coronary catheterization is highly dependent on the kidney function before contrast media administration and relevant risk factors, of which diabetes mellitus is the most important one.
Incidence of CIN ranges from <2% in the general population up to 50% in patients with Advanced Kidney Disease (AKD)2 and it is the third most common cause of hospital acquired renal failure.

Development of contrast media started by the first ionic, high-osmolar contrast agent (sodium acetrizoate) brought by Vernon Wallingford in 1953 and continued till development of the second generation non-ionic media in 1980’s. The exact mechanisms underlying CIN are still unclear. Scientific research for identification of renoprotective agents that can prevent CIN is continuously going on. These data suggest that nicorandil may protect the kidney against ischemic injury associated with the use of contrast media by decreasing calcium inflow to the  tubular cells, inhibiting the accumulation of reactive oxygen species, suppressing synthesis of endothelin-1, and inducing NO production.

All patients showed an estimated glomerular filtration rate <60 mL/min. The average percent increases in serum creatinine and cystatin C following PCI were significantly lower in the nicorandil
group. The average percent decline in the estimated glomerular filtration rate was lower in the nicorandil group. Accordingly, the incidence of CIN was significantly lower in the nicorandil group (2.0% vs. 10.7%, p<0.02). Univariate regression analysis revealed nicorandil IV infusion to be the only significant predictor of CIN development. The study still face the limitation of utilizing the
uncommonly used indicator of renal dysfunction; cystatin C, in addition to being a single center study.

The first one is that all patients in the second study underwent PCI, which means a higher mean contrast volume (140 ml vs. 125 ml). The second one is related to nicorandil infusion regimen. The recently published study by Nawa, et al.11 opens the door for more research work targeting the same subject.

Heart Res Open J. 2015; 2(4): e6-e8. doi: 10.17140/HROJ-2-e003