Aims To evaluate and compare the protective effect of trimetazidine and nicorandil on renal function in patients undergoing percutaneous coronary intervention.with estimated glomerular filtration (eGFR) > 60 ml/min / 1.7 m2.
Method: 161 patients who met the inclusion criteria were recruited and divided into control group (n=41), trimetazidine group (n=40), nicorandil group (n=40) and trimetazidine combined with nicorandil group (n=40). Both TMZ and nicorandil were administered orally 72 hours before and 48 hours after the procedure. All patients in the four groups were given intravenous saline (0.9%) at a rate of 1 ml/kg/h 6 hours before and 12 hours after the procedure. Serum creatinine (SCr), GFR were measured before and 48 hours after the procedure. An increase of 44mmol/L (0.5mg/dL) in SCr or 25% higher than basal levels at 48 hours after administered iodinated CM was diagnosed as CIN.
Results: (1) The baseline characteristics of the four groups were similar. (2) The SCr levels increased in control group (baseline 73.07±15.69 VS. after PCI 91.71±23.10 mmol/L), TMZ group (baseline 71.90±17.30 VS. after PCI 82.00±17.19 mmol/L), nicorandil group (baseline 72.23±15.95 VS. after PCI 81.45±18.30 mmol/L)and TMZ plus nicorandil group (baseline 71.13±13.50 VS. after PCI 73.35±12.64 mmol/L) at 48 hours after the procedure, all p values < 0.05. (3) The increment of SCr after PCI in control group (?Scr=18.63±9.21 mmol/L) is higher than TMZ group (?Scr=10.10±5.62 mmol/L) and nicorandil group (?Scr=9.23±5.60mmol/L), and is higher than TMZ plus nicorandil group (?Scr=2.23±1.42 mmol/L), all p values < 0.001. There was no statistical difference of increment of SCr between TMZ group and nicorandil group. (4) Contrast-induced nephropathy developed in 14.6% (6/41) in control group, 2.5%(1/40) in TMZ group and 2.5%(1/40) in nicorandil group (p<0.05), none in TMZ plus nicorandil group.
Conclusions: TMZ and nicorandil exerted similar protective effect on renal function by decreasing SCr level and CIN incidence after PCI. The efficacy of TMZ combined with nicorandil on renal protection was greater than TMZ or nicorandil alone.