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Published in: Journal of Anesthesia 4/2023

01-06-2023 | Nicorandil | Original Article

Effectiveness of intraoperative nicorandil in patients with a history of ischemic heart disease undergoing high-risk noncardiac surgery: a retrospective cohort study

Authors: Kentaro Miyake, Satomi Yoshida, Tomotsugu Seki, Woo Jin Joo, Masato Takeuchi, Koji Kawakami

Published in: Journal of Anesthesia | Issue 4/2023

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Abstract

Purpose

Nicorandil is occasionally administered to prevent myocardial ischemia during the perioperative period in patients with ischemic heart disease (IHD); however, its effectiveness has not been clarified. In this study, we examined the effectiveness of intraoperative nicorandil administration in noncardiac surgery.

Methods

We identified patients with a history of IHD who had undergone high-risk noncardiac surgery between April 2015 and March 2020 from a nationwide in-patient database in Japan. The patients were divided into those who received nicorandil (nicorandil group) and those who did not (control group). The primary outcome was the 30-day in-hospital mortality. The secondary outcome was major adverse cardiovascular events (MACE), defined as the composite outcome of the 30-day in-hospital mortality, acute myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting. One-to-one propensity score matching was performed. The outcomes were analyzed using a Cox proportional hazards model.

Results

Of 8037 patients, 2886 received nicorandil during surgery. After propensity score matching, 2554 pairs were analyzed. There was no significant difference in the 30-day in-hospital mortality (26 [1.02%] vs. 36 [1.41%]; hazard ratio [HR] 1.36; 95% confidence interval [CI] 0.82–2.26; P = 0.229) or incidence of MACE (42 [1.64%] vs. 55 [2.15%]; HR 1.24; 95% CI 0.86–1.93; P = 0.216) between the control and nicorandil groups.

Conclusion

The findings of this study suggest that intraoperative nicorandil administration is not associated with the 30-day in-hospital mortality in high-risk noncardiac surgery.
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Metadata
Title
Effectiveness of intraoperative nicorandil in patients with a history of ischemic heart disease undergoing high-risk noncardiac surgery: a retrospective cohort study
Authors
Kentaro Miyake
Satomi Yoshida
Tomotsugu Seki
Woo Jin Joo
Masato Takeuchi
Koji Kawakami
Publication date
01-06-2023
Publisher
Springer Nature Singapore
Published in
Journal of Anesthesia / Issue 4/2023
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-023-03204-5

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