Long-term Effects of Nicorandil Combined with Dihydropyridine Calcium Channel Blockers on Cardiovascular Outcomes in Patients with Coronary Heart Disease: A Real-world Observational Study

Objective: This study was aimed at investigating whether the addition of nicorandil to a dihydropyridine calcium channel blocker (DHP-CCB) regimen might decrease the occurrence of major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD). Methods: A multicenter, retrospective, real-world study was conducted. Between August 2002 and March 2020, 7413 eligible patients with CHD were divided into DHP-CCB plus nicorandil combination (n = 1843) and DHP-CCB (n = 5570) treatment groups. The primary outcome was MACE, defined as a composite of myocardial infarction, stroke, and all-cause mortality. Propensity score matching was used to adjust for confounding factors. Results: After propensity score matching, combination therapy, compared with DHP-CCBs alone, was associated with a lower risk of MACE (HR: 0.80, 95% CI: 0.67-0.97). The combination group also had a lower risk of stroke (HR: 0.55, 95% CI: 0.44-0.69), but not myocardial infarction (HR: 1.21, 95% CI: 0.91-1.61) or all-cause mortality (HR: 1.24, 95% CI: 0.63-2.44). Subgroup analysis revealed more prominent benefits of the combined treatment on MACE in patients with than without diabetes. Conclusions: The combination of nicorandil and DHP-CCBs may be more beneficial than DHP-CCBs alone in decreasing long-term risks of MACE and stroke in patients with CHD.