Effect of Perioperative Nicorandil on Myocardial Protection in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass, a Retrospective Study

Figures & data

Figure 1 Patient flow chart.

Abbreviations: PSM, propensity score matching; NICD, Nicorandil.

Table 1 Baseline Characteristics Before and After Propensity Score Matching

	Before Propensity Score Matching			After Propensity Score Matching
	Non-NICD N=2156	NICD N=250	p	Non-NICD N=750	NICD N=250	P
Age	51.7 (12.2)	58.0 (9.03)	<0.001	57.2 (9.00)	58.0 (9.03)	0.255
Gender,			<0.001			0.618
Male	1324 (61.4%)	188 (75.2%)		550 (73.3%)	188 (75.2%)
Female	832 (38.6%)	62 (24.8%)		200 (26.7%)	62 (24.8%)
Ethnicities			0.437			0.291
Han	2022 (93.8%)	237 (94.8%)		699 (93.2%)	237 (94.8%)
Meng	38 (1.76%)	6 (2.40%)		12 (1.60%)	6 (2.40%)
Man	41 (1.90%)	1 (0.40%)		17 (2.27%)	1 (0.40%)
Hui	26 (1.21%)	3 (1.20%)		13 (1.73%)	3 (1.20%)
Others	29 (1.35%)	3 (1.20%)		9 (1.20%)	3 (1.20%)
NYHA class			0.035			0.970
1	275 (12.8%)	17 (6.80%)		56 (7.47%)	17 (6.80%)
2	1130 (52.4%)	139 (55.6%)		404 (53.9%)	139 (55.6%)
3	716 (33.2%)	91 (36.4%)		281 (37.5%)	91 (36.4%)
4	35 (1.62%)	3 (1.20%)		9 (1.20%)	3 (1.20%)
Height	167 (8.08)	168 (7.60)	0.048	168 (8.02)	168 (7.60)	0.625
Weight	68.3 (12.6)	73.3 (12.2)	<0.001	72.4 (12.5)	73.3 (12.2)	0.311
BMI	24.3 (3.54)	25.8 (3.41)	<0.001	25.6 (3.47)	25.8 (3.41)	0.461
Heart rate	78.7 (14.4)	73.5 (11.7)	<0.001	74.9 (12.3)	73.5 (11.7)	0.089
SBP	127 (18.1)	135 (19.4)	<0.001	132 (18.5)	135 (19.4)	0.066
DBP	73.1 (12.2)	77.8 (12.4)	<0.001	75.9 (11.6)	77.8 (12.4)	0.032
LVEF	61.4 (6.09)	59.7 (6.69)	<0.001	60.3 (6.67)	59.7 (6.69)	0.203
WBC	6.22 (1.63)	6.79 (1.70)	<0.001	6.59 (1.72)	6.79 (1.70)	0.110
Hgb	138 (17.7)	136 (16.7)	0.029	137 (15.4)	136 (16.7)	0.179
ALT	24.6 (31.4)	28.7 (21.9)	0.008	28.5 (45.2)	28.7 (21.9)	0.952
AST	28.0 (17.0)	29.4 (16.6)	0.197	29.3 (17.1)	29.4 (16.6)	0.899
ALP	67.6 (22.3)	71.7 (20.4)	0.002	69.2 (21.4)	71.7 (20.4)	0.098
GGT	36.2 (42.4)	36.3 (41.6)	0.959	38.8 (49.2)	36.3 (41.6)	0.447
Dbil	4.37 (4.08)	3.46 (2.35)	<0.001	3.63 (2.08)	3.46 (2.35)	0.330
Tbil	14.2 (9.31)	11.6 (5.45)	<0.001	12.1 (5.46)	11.6 (5.45)	0.158
Cr	84.1 (18.4)	87.1 (18.7)	0.016	86.9 (18.5)	87.1 (18.7)	0.869
BUN	6.37 (2.24)	6.13 (2.20)	0.105	6.32 (2.16)	6.13 (2.20)	0.244
Total Protein	68.3 (5.68)	67.6 (5.50)	0.060	67.8 (5.50)	67.6 (5.50)	0.620
ALB	39.9 (3.36)	39.6 (3.24)	0.129	39.6 (3.28)	39.6 (3.24)	0.877
PT	13.5 (1.64)	13.1 (1.67)	0.002	13.3 (1.70)	13.1 (1.67)	0.108
D-dimer	0.47 (1.28)	0.34 (0.48)	0.001	0.35 (0.41)	0.34 (0.48)	0.793
NT-proBNP	727 (1232)	531 (944)	0.003	603 (901)	531 (944)	0.295
hsCRP	2.04 (3.04)	2.78 (3.36)	0.001	2.42 (3.36)	2.78 (3.36)	0.141
Diabetes,	201 (9.32%)	58 (23.2%)	<0.001	148 (19.7%)	58 (23.2%)	0.279
Smoking,	699 (32.4%)	123 (49.2%)	<0.001	341 (45.5%)	123 (49.2%)	0.341
Hypertension	712 (33.0%)	103 (41.2%)	0.012	302 (40.3%)	103 (41.2%)	0.852
Stroke history	30 (1.39%)	10 (4.00%)	0.006	23 (3.07%)	10 (4.00%)	0.609
Blood recovery volume	214 (154)	202 (18.2)	0.001	204 (36.4)	202 (18.2)	0.264
Bypass time	124 (55.9)	119 (40.5)	0.079	120 (49.1)	119 (40.5)	0.742
Aortic clamp duration	87.8 (42.3)	87.4 (34.1)	0.837	85.1 (37.2)	87.4 (34.1)	0.380

Abbreviations, NICD, Nicorandil; NYHA, New York Heart Association functional class; BMI, Body Mass Index; SBP, Systolic Blood Pressure; DBP, Diastolic Blood Pressure; LVEF, Left Ventricular Ejection Fraction; WBC, White Blood Cell; Hgb, Hemoglobin; ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; ALP, Alkaline Phosphatase; GGT, Gamma-glutamyltransferase; Dbil, Direct Bilirubin; Tbil, Total Bilirubin; Cr, Creatinine; BUN, Blood Urea Nitrogen; ALB, Albumin; PT, Prothrombin Time; NT-proBNP, N-Terminal Pro-Brain Natriuretic Peptide; Hs-CRP, hypersensitive C-reactive Protein.

Figure 2 The SMD of covariates before and after propensity score matching.

Abbreviations: SMD, Standardized mean difference; NYHA, New York Heart Association functional class; SBP, Systolic Blood Pressure; LVEF, Left Ventricular Ejection Fraction; WBC, White Blood Cell; Hgb, Hemoglobin; Dbil, Direct Bilirubin; Tbil, Total Bilirubin; Cr, Creatinine; NT-pro BNP, N-Terminal Pro-Brain Natriuretic Peptide; hsCRP, hypersensitive C-reactive Protein.

Table 2 Propensity Score-Matched Analysis of Primary Outcome and Secondary Outcomes

	Non-NICD N=750	NICD N=250	OR	p.ratio	p.overall
PMI	354 (47.2%)	97 (38.8%)	0.71 [0.53;0.95]	0.021	0.025
Drainage volume	697 (713)	678 (486)	1.00 [1.00;1.00]	0.691	0.633
MV duration	19.1 (30.7)	17.8 (18.8)	1.00 [0.99;1.00]	0.512	0.403
ICU LOS	2.60 (2.19)	2.45 (1.74)	0.96 [0.89;1.04]	0.318	0.263
Drainage time	4.10 (2.21)	3.88 (1.59)	0.94 [0.87;1.02]	0.140	0.083
Hospital LOS	8.22 (3.20)	8.15 (2.58)	0.99 [0.95;1.04]	0.743	0.715
Cost	126,665 (50,205)	125,215 (29,478)	1.00 [1.00;1.00]	0.666	0.579
ALI	53 (7.07%)	13 (5.20%)	0.73 [0.37;1.32]	0.308	0.378
AKI	32 (4.27%)	9 (3.60%)	0.85 [0.37;1.74]	0.667	0.782

Abbreviations, NICD, Nicorandil; OR, Odds Ratio; PMI, Perioperative Myocardial Injury; MV, Mechanical ventilation; ICU LOS, Intensive Care Unit length of stay; Hospital LOS, hospital length of stay; ALI, acute liver injury; AKI, acute kidney injury.

Table 3 PSM Analysis of Primary Outcome and Secondary Outcomes When Using Nicorandil Preoperatively

	Non-NICD N=453	NICD N=151	OR	P.ratio
PMI	207 (45.7%)	54 (35.8%)	0.66 [0.45;0.97]	0.033
Drainage volume	762 (773)	694 (548)	1.00 [1.00;1.00]	0.317
MV duration	18.9 (28.8)	16.1 (12.3)	0.99 [0.98;1.01]	0.257
ICU LOS	2.59 (2.08)	2.28 (1.50)	0.91 [0.81;1.02]	0.093
Drainage time	4.25 (2.51)	3.69 (1.65)	0.87 [0.79;0.97]	0.011
Hospital LOS	8.38 (3.35)	7.77 (2.28)	0.93 [0.86;1.00]	0.040
Cost	126,195 (48,635)	121,087 (25,352)	1.00 [1.00;1.00]	0.220
ALI	40 (8.83%)	5 (3.31%)	0.36 [0.12;0.86]	0.019
AKI	13 (2.87%)	1 (0.66%)	0.26 [0.01;1.31]	0.153

Abbreviations: PSM, Propensity Score Matching; NICD, Nicorandil; OR, Odds Ratio; PMI, Perioperative Myocardial Injury; MV, Mechanical ventilation; ICU LOS, Intensive Care Unit length of stay; Hospital LOS, hospital length of stay; ALI, acute liver injury; AKI, acute kidney injury.

Table 4 PSM Analysis of Primary Outcome and Secondary Outcomes When Using Nicorandil Postoperatively

	Non-NICD N=297	NICD N=99	OR	P.ratio
Myocardial injury	150 (50.5%)	43 (43.4%)	0.75 [0.47;1.19]	0.224
Drainage volume	674 (781)	653 (373)	1.00 [1.00;1.00]	0.794
MV duration	19.8 (32.8)	20.3 (25.6)	1.00 [0.99;1.01]	0.896
ICU-LOS	2.64 (2.25)	2.71 (2.05)	1.01 [0.91;1.12]	0.807
Drainage time	4.02 (2.10)	4.16 (1.45)	1.04 [0.93;1.16]	0.534
Hospital-LOS	8.14 (3.37)	8.74 (2.90)	1.05 [0.99;1.12]	0.120
Cost	128,171 (53,462)	131,512 (34,026)	1.00 [1.00;1.00]	0.561
ALI	15 (5.05%)	8 (8.08%)	1.66 [0.64;4.00]	0.280
AKI	17 (5.72%)	8 (8.08%)	1.46 [0.57;3.43]	0.410

Abbreviations: PSM, Propensity Score Matching; NICD, Nicorandil; OR, Odds Ratio; PMI, Perioperative Myocardial Injury; MV, Mechanical ventilation; ICU LOS, Intensive Care Unit length of stay; Hospital LOS, hospital length of stay; ALI, acute liver injury; AKI, acute kidney injury.