scholarly journals The Efficacy and Safety of Nicorandil for Periprocedural Myocardial Injury in Patients Undergoing PCI: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Yuanxi Lu ◽  
Wenbiao Hu ◽  
Qinghua Song ◽  
Qiwu Wang
Keyword(s):  
Myocardial Injury ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Control Group ◽  
Efficacy And Safety ◽  
Percutaneous Coronary ◽  
Early Use ◽  
Experimental Group ◽  
Periprocedural Myocardial Injury

Purpose. To evaluate the efficacy and safety of nicorandil for periprocedural myocardial injury in patients undergoing PCI through meta-analysis of randomized controlled trials. Methods. We analyzed the clinical data of patients including the incidence of periprocedural myocardial injury (PMI) and major adverse cardiovascular events (MACE) from selected articles. RCTs were retrieved from medical literature databases. RR and 95% confidence intervals (CI) were calculated to compare the endpoints. Results. In total, 15 articles (16 trial comparisons) were retrieved which contained 2221 patients. In general, 1130 patients (50.9%) were randomized to the experimental group, whereas 1091 patients (49.1%) were randomized to the control group. The result showed that nicorandil significantly reduced the incidence of PMI and MACE after PCI compared to the control group. Conclusions. Overall, early use of nicorandil in patients undergoing percutaneous coronary intervention (PCI) was associated with a significant reduction of PMI and MACE.

Nicorandil for Periprocedural Myocardial Injury in Elective Percutaneous Coronary Intervention: A Meta-Analysis of 10 Randomized Controlled Trials

Angiology ◽  
2020 ◽  
Vol 71 (7) ◽  
pp. 609-615
Author(s):  
Bin Yi ◽  
Jinwen Luo ◽  
Yumei Jiang ◽  
Shaoyan Mo ◽  
Xiaoyi Xiao ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Randomized Controlled Trials ◽  
Myocardial Injury ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Percutaneous Coronary ◽  
Periprocedural Myocardial Injury

The clinical outcomes of nicorandil in percutaneous coronary intervention (PCI) are conflicting. We sought to evaluate the effects of nicorandil on periprocedural myocardial injury (PMI) in elective PCI. Eligible studies that reported the effect of nicorandil on PMI in elective PCI were obtained from PubMed, Web of Science, and Cochrane Library (up to October 28, 2019). The outcomes were PMI and major adverse cardiovascular and cerebrovascular events (MACCEs). Ten randomized controlled trials with 1304 patients undergoing elective PCI were evaluated. Nicorandil significantly reduced the incidence of PMI (odds ratio [OR] = 0.48; P = .0003); however, there was no significant difference in MACCEs (OR = 0.80; P = .45) between the 2 groups. Subgroup analyses showed that nicorandil significantly lowered the PMI risk when only patients with stable coronary artery disease (OR = 0.41; P = .0008) were considered and when nicorandil was administered intravenously (OR = 0.41; P = .0007) or orally (OR = 0.33; P = .0001). This meta-analysis suggests that nicorandil could reduce the incidence of PMI without increasing the occurrence of MACCEs in elective PCI. The effect of nicorandil in lowering the PMI risk is associated with the diagnosis of the patients and the route of nicorandil administration.

scholarly journals Effectiveness of Ranolazine to Prevent Myocardial Injury During Elective Percutaneous Coronary Intervention

2019 ◽  
Vol 10 (1) ◽  
pp. 43-49
Author(s):  
SM Mamun Iqbal ◽  
Syed Ali Ahsan ◽  
Kasekh Akhtar Jahan ◽  
Sohely Nazneen Eva
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Myocardial Injury ◽  
Troponin I ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Control Group ◽  
Interventional Study ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Periprocedural Myocardial Injury

Background: Ranolazine is a novel antianginal drug that reduces intracellular accumulation of calcium ion in ischemic myocardium. A pilot randomized study (n=70) has shown that pretreatment with ranolazine 1000mg twice daily for 7days significantly reduced periprocedural myocardial injury (PMI) in elective Percutaneous coronary intervention (PCI). Our objective was to detect whether similar effect could be obtained by ranolazine pretreatment through an interventional study. Materials & Methods: 110 patients with chronic stable angina scheduled for elective PCI were enrolled in an interventional study. For 7 days before the procedure, 55 patients were allocated to receive ranolazine 1000 mg twice daily (ranolazine group) and 55 patients didn't receive ranolazine (control group). Serum creatinine kinase-MB (CK-MB) and Troponin I levels were measured at baseline and 24 hours post procedure. Results: Periprocedural myocardial injury [i.e. an elevation of serum biomarkers (preferably cardiac troponins) above the 99th percentile of upper reference limit (URL)] was detected less commonly after PCI in ranolazine than in control group (11% vs. 27%, p=0.0001). Also, PCI-related myocardial infarction [i.e., post procedural increase in CK-MB>3 times above the URL] tended to be lower in the ranolazine versus placebo group: 1.8% versus 5.45%, P=0.0002. 24 hours post procedural levels of cardiac markers were also significantly lower in the ranolazine versus control group (CK-MB: 2.42±2.05 versus 7.02±9 ng/ml, P=0.001; Troponin 1: 0.447±0.74 versus 1.18±1.6 ng/ml, P=0.004). No significant adverse effect of the drug was reported. Conclusion: So, we have concluded that ranolazine was effective in significantly reducing the periprocedural myocardial injury in elective PCI. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 43-49

Effect of Alprostadil on the Prevention of Contrast-Induced Nephropathy: A Meta-Analysis of 36 Randomized Controlled Trials

Angiology ◽  
2019 ◽  
Vol 70 (7) ◽  
pp. 594-612 ◽  
Author(s):  
Jian Xie ◽  
Mingyang Jiang ◽  
Yunni Lin ◽  
Huachu Deng ◽  
Lang Li
Keyword(s):  
Cystatin C ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Control Group ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary ◽  
Intrarenal Blood Flow ◽  
And Control ◽  
Experimental Group ◽  
Different Doses

Contrast-induced nephropathy (CIN) is the third leading cause of acquired acute renal injury in hospitalized patients. Alprostadil plays a role in the maintenance and redistribution of intrarenal blood flow and the excretion of electrolytes and water. However, the effectiveness of alprostadil in preventing CIN remains controversial. Thirty-six articles with a total of 5495 patients were included in this study. Both groups (experimental group and control group) received standard hydration therapy. In the experimental group, patients received different doses of alprostadil. Serum creatinine (SCr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), cystatin C, creatinine clearance rate (CCr), and β2-microglobulin (β2-MG) were measured at 24, 48, and 72 hours after contrast media injection. The incidence of CIN in the experimental group was significantly lower than that in the control group (6.56% vs 16.74%). The level of SCr, cystatin C, BUN, and β2-MG in the experimental group was lower than those in the control group; CCr and eGFR in the experimental group were higher than those in the control group. This study demonstrated that alprostadil may reduce the incidence of CIN in patients undergoing coronary angiogram and/or percutaneous coronary intervention.

Efficacy of Trimetazidine in Limiting Periprocedural Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Angiology ◽  
2021 ◽  
pp. 000331972098774
Author(s):  
Chang Wang ◽  
Weiwei Chen ◽  
Ming Yu ◽  
Ping Yang
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Myocardial Injury ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Current Evidence ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Periprocedural Myocardial Injury

We systematically searched the literature to assess the efficacy of trimetazidine in reducing periprocedural myocardial injury and improving postoperative left ventricular ejection fraction (LVEF) in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). An electronic search was conducted based on the PubMed, Ovid, Scopus, Springer, CENTRAL, and Google Scholar databases; 14 randomized controlled trials (RCTs) were included. Our meta-analysis showed a significant reduction in cardiac troponin I (cTnI) levels with trimetazidine compared with controls ( P < .00001) but not in serum creatine kinase-myocardial band levels ( P = .49). There were significantly reduced odds of ischemic ST-T segment changes with trimetazidine ( P = .0.03) but lack of significant difference in the incidence of anginal attacks between the 2 groups ( P = .10). Results also suggest significantly higher LVEF with trimetazidine compared with controls ( P < .00001). Meta-regression analysis indicated no influence of duration of trimetazidine therapy on cTnI levels. The administration of preprocedure trimetazidine may have a role in reducing periprocedural myocardial injury in patients with CAD undergoing PCI. Evidence also suggests that postoperative trimetazidine may improve LVEF in the short term. Lack of high-quality trials and the heterogeneity of studies limit the ability of our analysis to draw strong conclusions. Further well-designed RCTs are required to supplement current evidence.

Abstract 291: Platelet Function Monitoring After Percutaneous Coronary Intervention: Updated Meta-analysis of Randomized Trials.

2017 ◽  
Vol 121 (suppl_1) ◽  
Author(s):  
Akintunde M Akinjero ◽  
Oluwole Adegbala ◽  
Esosa Edo-Osagie ◽  
Nike Akinjero ◽  
Tomi Akinyemiju
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Platelet Function ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Bleeding Complications ◽  
Major Adverse Cardiovascular Events ◽  
Future Research ◽  
Funnel Plot ◽  
Percutaneous Coronary

Background: The need to balance bleeding and clotting risks after percutaneous coronary intervention (PCI) has led to interest in platelet function monitoring as a strategy to improve post-PCI outcomes. The prognostic value of platelet function testing in monitoring response to antiplatelet therapy after PCI remains unclear. Prior studies have been inconclusive. We sought to conduct an updated meta-analysis to address this gap in knowledge. Methods: We conducted a systematic search of EMBASE, PUBMED and the Cochrane libraries for studies since inception to December 2016 on platelet function monitoring. Our search yielded 203 studies, out of which 83 were extracted for full-text review. Only 3 studies met inclusion criteria. We pooled odds ratios using random-effects statistics, Mantel-Haenszel method. I2 and Chi- squared statistic was used to evaluate for heterogeneity. Publication bias was assessed using the funnel plot. Primary outcome was major adverse cardiovascular events (MACE). This was defined in the studies as a composite of cardiovascular death, myocardial infarction, stroke, stent thrombosis, and bleeding complications. Results: The 3 randomized controlled trials that were analyzed involved 3701 patients. There were 550 MACE (29.76%) in the platelet function monitored group compared with 514 (27.74%) in the control. MACE (Figure 1) was not significantly higher for the platelet function monitored group during follow-up compared with control (pooled Odds Ratio:1.11 [95% CI: 0.96-1.28], p = 0.15). Tests for heterogeneity were not significant, with I2 of 0%, Chi2 = 1.52 (p = 0.47); and small study bias was absent on visual inspection of the funnel plot. Conclusions: Platelet function monitoring continues to be used in practice. Results from this meta-analysis show no benefit of platelet function monitoring compared with conventional strategy with regards to MACE after PCI. Future research is needed to further evaluate this finding.

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