The Predictive Value of Oral Nicorandil on Contrast Induced Nephropathy in Patients with Renal Insufficiency Undergoing Cardiac Catheterization in Non ST Segment Elevation Acute Coronary Syndrome

Abstract

IN is an elevation of the level of serum creatinine level 44.2 μmol/l (0.5 mg/dL) or 25% above the baseline within 48–72 hours post CM exposure without an alternative cause (Chyou et al., 2015). CIN risk is elevated in CKD patients, which is defined as eGFR of < 60 mL/min per 1.73 m2. Certain precautions should be followed when giving contrast to CKD patients (McCullough, 2008). Risk classification scoring systems have been established to estimate an individual’s risk of CIN. This is used in patients planned for PCI, specifically in the presence of risk factors. Mehran et al made a scoring system depending on points scored to each of the following: hypotension, IABP use, CHF, serum creatinine >1.5 mg/dL, age >75 years, anemia, DM and contrast volume. Risk groups by the calculated score are as low risk, moderate risk, high risk and very high risk (Mehran et al., 2006). Several regimens, such as hydration, statins, sodium Bicarbonate, B-type natriuretic peptide, fenoldopam, N-acetylcysteine and dopamine have been tried to minimize this complication. However, the optimal strategy remains unclear. Nicorandil acts as a vasodilator and is used to manage angina and CHF (Hornaka et al., 2010). The rationale for using it in the current study returns to the pathophysiology of CIN which involves two components: vasoactive mediator-related vasoconstriction with resultant renal ischemia, and the direct tubule-toxicity exerted by CM (Goldenberg et al., 2005). The current study was done on 100 patients with renal impairment (eGFR ≤60 mL/min/1.73m2), categorized as low risk and intermediate risk zone by Mehran CIN risk score, and planned for CA in NSTACS. Patients were allocated into two groups, each group was 50 patients, according to the administration of Nicorandil 20 mg daily (10mg BID) from 1 day pre to 3 days post the procedure, along with the standard saline hydration in Nicorandil group. While in control group, patients received only the standard saline hydration. There was a significant difference regarding the frequency of CIN occurrence among Nicorandil versus control group reflecting the protective role of Nicorandil against CIN. Also both DM and increased volume of CM were predictors of CIN occurrence.