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

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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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Data availability

The study data is from a commercial database and could be obtained from Medical Data Vision Co., Ltd., through the appropriate procedure.

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Acknowledgements

We acknowledge Mr. Masaki Nakamura and the staff at Medical Data Vision, Co, Ltd. (Tokyo, Japan) for data preparation assistance for free. We also thank Editage (http://www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Kentaro Miyake, Satomi Yoshida, Woo Jin Joo, Masato Takeuchi & Koji Kawakami

  2. Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Tomotsugu Seki

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  1. Kentaro Miyake
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  2. Satomi Yoshida
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  3. Tomotsugu Seki
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Contributions

KM: Study design, data collection, analysis and interpretation, study administration, and manuscript preparation; SY: Study design, data analysis, data interpretation, manuscript revision, and final manuscript approval; TS: Study design, data interpretation, manuscript revision, and final manuscript approval; WJJ: Study design, data interpretation, manuscript revision, and final manuscript approval; MT: Study design, data interpretation, manuscript revision, and final manuscript approval; KK: Study design, data interpretation, manuscript revision, and final manuscript approval.

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Correspondence to Koji Kawakami.

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Miyake, K., Yoshida, S., Seki, T. et al. Effectiveness of intraoperative nicorandil in patients with a history of ischemic heart disease undergoing high-risk noncardiac surgery: a retrospective cohort study. J Anesth 37, 562–572 (2023). https://doi.org/10.1007/s00540-023-03204-5

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