Nicorandil 10mg tablets

BackgroundAnthracyclines are cornerstone chemotherapeutics, but cardiotoxicity limits their use.ObjectiveThis study aims to evaluate the efficacy of various drugs in preventing and treating anthracycline-induced cardiotoxicity (AIC).MethodsWe conducted an extensive search across seven databases to identify randomized controlled trials (RCTs) pertinent to the prevention and treatment of AIC with medications. Subsequently, a Bayesian Model-based network meta-analysis was performed in the R 4.4.0.ResultsA total of 128 RCTs involving 10,431 cancer patients treated with anthracyclines and 78 drug regimens were included in this study. The network meta-analysis results showed that, compared with patients who did not receive cardioprotective drugs, those treated with Calcium Dibutyryladenosine Cyclophosphate (Mean Difference [95% Credible Interval], 8.760 [0.5917, 16.92]), Carvedilol (4.024 [0.5372, 7.656]), Carvedilol + Candesartan (7.934 [3.159, 12.91]), Compound Salvia Miltiorrhiza + Levocarnitine (9.087 [0.9160, 17.25]), Dexrazoxane (5.066 [2.589, 7.540]), Dexrazoxane + Cinobufacini (11.61 [4.590, 18.70]), Dexrazoxane + Shenqi Fuzheng (13.05 [4.640, 21.40]), Nicorandil (14.24 [5.122, 23.31]), Qiliqiangxin (11.38 [2.826, 19.91]), and Xinmai Long (6.371 [1.735, 11.02]) experienced less decrease in LVEF after chemotherapy. The SUCRA ranking results indicated that the most effective treatment option for preserving LVEF was Nicorandil (SUCRA 91.76%).ConclusionApart from Dexrazoxane, Carvedilol, a β-blocker, also appears to show significant potential in preventing AIC. Furthermore, our results indicate that there is insufficient evidence to support the beneficial effects of statins, Sildenafil, Ivabradine, Levocarnitine, N-acetylcysteine, Glutathione, Coenzyme Q10, Vitamin E, and Vitamin C in preventing LVEF decline and exerting a positive effect on the prevention of AIC.

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BackgroundContrast-induced nephropathy (CIN) remains a significant complication in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI).MethodsA comprehensive literature search was conducted across PubMed, MEDLINE, Embase, Google Scholar, and Web of Science up to May 2024 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of nicorandil in patients undergoing CAG or PCI. The primary outcome was CIN incidence, while secondary outcomes included, changes in serum creatinine, serum cystatin C, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). Risk ratios (RRs) and standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I2 statistic.ResultsEleven RCTs and one prospective cohort study involving 2910 patients were included. Nicorandil administration was associated with a significant reduction in CIN incidence (RR: 0.40 [0.31-0.52], P P P = 0.02) demonstrating efficacy (p-interaction = 0.22). Patients receiving nicorandil exhibited significantly lower serum creatinine levels at 48 hours (SMD: -0.34 [-0.52, -0.16], P = 0.0002) and 72 hours (SMD: -0.24 [-0.40, -0.08], P = 0.003) post-procedure. Serum cystatin C was also significantly reduced at 48 hours (SMD: -0.48 [-0.81, -0.15], P = 0.004). However, nicorandil did not produce a significant change in eGFR at 24 hours (SMD: 0.17 [-0.07, 0.41], P = 0.17), 48 hours (SMD: 0.13 [-0.10, 0.37], P = 0.26), or 72 hours (SMD: 0.19 [-0.07, 0.45], P = 0.36).ConclusionNicorandil administration reduces CIN incidence and improves renal biomarker profiles in patients undergoing CAG and PCI. Further large-scale trials are necessary to validate its renoprotective properties.

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Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease, but it carries a risk of periprocedural myocardial injury (PMI). This meta-analysis evaluated the efficacy of nicorandil, a hybrid compound with nitrate-like and potassium channel-opening properties, in preventing PMI during PCI. A comprehensive literature search identified 14 studies involving 1,762 patients, with 882 receiving nicorandil and 880 in the control group. The analysis revealed that nicorandil significantly reduced the incidence of PMI (RR: 0.73, 95% CI: 0.61-0.86) and major adverse cardiovascular events (MACE) (RR: 0.76, 95% CI: 0.58-0.99) compared to the control group. Nicorandil's cardioprotective effects are attributed to its ability to improve coronary blood flow, precondition the myocardium, and reduce oxidative stress and inflammation. These findings suggest that nicorandil could be a valuable adjunctive therapy during PCI, potentially improving patient outcomes. However, the study had limitations, including variations in drug administration methods and a lack of individual-level data for subgroup analysis. Future research should focus on optimizing dosing regimens and administration timing and comparing nicorandil's effectiveness with other cardioprotective agents.

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AimsThis network meta-analysis of randomized controlled trials (RCTs) evaluates the comparative safety and efficacy of intra-coronary (IC) pharmacological and procedural treatments-on top of balloon angioplasty and stent placement-on clinical outcomes and surrogate endpoints of coronary microvascular obstruction (CMVO) in patients with ST-elevation myocardial infarction (STEMI).Methods and resultsTwo electronic databases were searched for eligible studies. Primary efficacy endpoints included all-cause mortality, non-fatal myocardial infarction (MI), and heart failure (HF) hospitalization. Primary safety endpoints included peri-procedural arrhythmias including atrioventricular blocks (AVBs) and ventricular fibrillation/sustained ventricular tachycardia (VF/SVT), any bleeding, and stroke. Secondary efficacy endpoints included the occurrence of post-procedural thrombolysis in myocardial infarction (TIMI) flow grade 0-2 and ST-segment resolution. A total of 64 RCTs involving 27 243 patients were included. In mixed comparisons, no treatment significantly reduced the incidence of primary efficacy endpoints compared to conventional primary PCI during a mean follow-up of 8 months. Several treatments significantly reduced the occurrence of post-PCI TIMI 0-2 flow grade [adenosine: 0.40 (odds ratio), (95% Confidence Interval 0.24-0.68); verapamil: 0.22 (0.07-0.69); tirofiban: 0.43 (0.27-0.71); manual thrombus aspiration (TA): 0.61 (0.45-0.82); fibrinolytic + manual TA: 0.24 (0.12-0.48); tirofiban + manual TA: 0.32 (0.14-0.75)], compared to conventional primary PCI. IC administration of tirofiban increased the risk of any bleeding [incidence rate ratio: 1.65 (1.11-2.45)], while IC adenosine increased the risk of peri-procedural AVBs [OR: 2.80 (1.14-6.84)]. Nicorandil reduced the incidence of peri-procedural VF/SVT [OR: 0.31 (0.12-0.81)].ConclusionAdjunctive IC treatments during primary PCI do not influence hard clinical outcomes compared to conventional therapy within a mean 8-month follow-up, although several of them lead to an improvement in surrogate endpoints of CMVO.Study registration numberCRD42023468559.

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