Chest pain drug lowers risk of kidney injury after PCI
Oral nicorandil can reduce the risk of contrast-associated acute kidney injury (CA-AKI) when patients with renal dysfunction undergo percutaneous coronary intervention (PCI), according to new research published in Circulation: Cardiovascular Interventions.[1] The greatest impact was seen in patients receiving three high doses of the medication per day.
Nicorandil is currently indicated for the treatment of angina. Because it is associated with improved hemodynamics in addition to anti-oxidant and anti-apoptotic benefits, the team behind this study hoped to learn more about its potential effect on high-risk PCI patients who present with renal dysfunction.
Researchers focused on more than 600 patients with renal dysfunction who underwent PCI from 2022 to 2025. While approximately one-third of those patients received 5 mg of nicorandil three times per day, another one-third received 10 mg of nicorandil three times per day. The remaining patients received no nicorandil and served as the study’s control group.
Overall, the rates of CA-AKI within 72 hours were 8.7% for the high-dose group, 10.9% for the conventional dose group and 19.8% for the control group. High-dose nicorandil was linked to a 61% relative risk reduction without significantly increasing the risk of adverse events.
“The dose-dependent efficacy observed in our trial is likely rooted in the underlying pathophysiology of renal dysfunction. In patients with chronic kidney disease, the downregulation of ATP-sensitive potassium channels and impaired renal microcirculation may attenuate the response to conventional doses of nicorandil,” wrote first author Minqi Liao, MM, a researcher with Dongguan People’s Hospital in China, and colleagues. “Consequently , a higher dose appears necessary to achieve sufficient renal vasodilation, enhance medullary oxygenation, and exert anti-oxidant and anti-apoptotic effects.”
In patients with hyperuricemia, conventional doses of nicorandil were not associated with significant benefits. Higher doses, on the other hand, were still effective.
“This interaction suggests that higher doses of nicorandil are required to effectively counteract hyperuricemia-related pathways, such as oxidative stress, endothelial dysfunction or reduced nitric oxide bioavailability,” the authors wrote. “To our knowledge, no prior CA-AKI prevention trial has specifically examined hyperuricemia as an effect modifier. If validated in future prospective studies, these exploratory findings could pave the way for personalized dosing strategies, suggesting that hyperuricemic patients require high-dose achieve sufficient benefit from conventional doses.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.