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Comparison of renal outcome with renote ischemic preconditioning versus nicorandil following percutaneous coronary intervention in stable angina patients; results from the RINC trial

Session Poster session 1

Speaker Toshiaki Yamanaka

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : T Yamanaka (Tsuyama,JP), T Miyoshi (Okayama,JP), K Ejiri (Okayama,JP), K Kohno (Okayama,JP), M Nakahama (Fukuyama,JP), M Doi (Takamatsu,JP), M Munemasa (Okayama,JP), M Murakami (Okayama,JP), A Takaishi (Kagawa,JP), K Nakamura (Okayama,JP), H Ito (Okayama,JP)

Authors:
T. Yamanaka1 , T. Miyoshi2 , K. Ejiri2 , K. Kohno2 , M. Nakahama3 , M. Doi4 , M. Munemasa5 , M. Murakami6 , A. Takaishi7 , K. Nakamura2 , H. Ito2 , 1Tsuyama Central Hospital - Tsuyama - Japan , 2Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences - Okayama - Japan , 3Fukuyama City Hospital - Fukuyama - Japan , 4Kagawa Prefectural Central Hospital - Takamatsu - Japan , 5Okayama Medical Center - Okayama - Japan , 6Okayama Heart Clinic - Okayama - Japan , 7Mitoyo General Hospital - Kagawa - Japan ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 182

Background: Contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) is an independent predictor of adverse clinical outcome. Both treatment with remote ischemic preconditioning (RIPC) and intravenous nicorandil were promising for reducing CIN in patients undergoing elective PCI.

Purpose: To compare the impact on renal function following PCI between treatment with RIPC and with continuous infusion of nicorandil in the data from the RINC study: multi-center randomized controlled trial tested the incidence of periprocedural myocardial injury after elective PCI in patients with stable coronary artery disease by comparing among remote ischemic preconditioning (RIPC), nicorandil and the control groups.

Methods: In the principal study, a total of 405 patients with stable angina who planed elective PCI were randomly assigned into a 1:1:1 ratio to control, continuous infusion of nicorandil (6mg/h), or RIPC. RIPC was performed with the newly developed device that performs three cycles of upper-limb ischemia (5-minute blood-pressure cuff inflation >200 mmHg and followed by 5-minute cuff deflation) automatically. The outcomes of this sub-study were the change in serum creatinine and estimated glomerular filtration rate (eGFR) for 24 h after PCI.

Results: This substudy analyzed 146 patients (whose creatinine was available both at baseline and 24h in data sets of the RIPC and the nicorandil group). Baseline characteristic including age, gender, and risk factors did not differ between two groups. Mehran risk scores in the RIPC and nicorandil group were 5.0±3.5 and 4.8±3.6 (p=0.73). In all patients, there was no difference in the increase in serum creatinine between the RIPC and the nicorandil group (0.89±0.22 vs. 0.96±0.40, mg/dl, p=0.24), but the decrease in eGFR in the nicorandil group was significantly greater than that in the RIPC group (0.9±10.0 and -2.4±9.1, %), p=0.04). Furthermore, in patients with eGFR <60 ml/min/1.73m2, both changes in serum creatinine and eGFR in the RIPC group were favorable compared to the nicorandil group, (1.06±0.25 vs. 1.27±0.46, mg/dl, p=0.04) and (3.1±10.9 and -2.2±9.3, %), p=0.05).

Conclusion: RIPC may preserve kidney function more than nicorandil in patients with stable angina following elective PCI.

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