Nicorandil significantly reducted the incidence of major coronary events in patients with
stable angina in a long-term trial, although there are few reports on its short-term efficacy in the treatment and prevention of angina symptoms. We performed a meta-analysis of the short-term efficacy of
nicorandil compared with antianginal drugs for
stable angina. We selected 20 reports (vs. β-blockers, n=6; vs.
nitrates, n=6; vs.
calcium antagonists, n=8) of prospective controlled trials from MEDLINE, the Cochrane Library, and Japana Centra Revuo Medicina. The trials were short in duration (median 5 weeks). We combined the results using odds ratios (OR) for discrete data and weighted mean differences (WMD) for continuous data. Compared with antianginal drugs,
nicorandil did not show significant reduction of angina episodes per week (vs. β-blockers, -1.50 [95% confidence interval (CI): -4.09, 1.09]; vs.
nitrates, 0.22 [95% CI: -1.22, 1.65]; vs.
calcium antagonists, -0.23 [95% CI: -1.37, 0.90]). Furthermore, there were no significant differences in time to
ischemia (total exercise duration, time to 1-mm ST depression, time to onset of
pain). Although the total numbers of adverse events with each antianginal
drug were similar, heart rate and blood pressure were significantly decreased by
calcium antagonists but not changed by
nicorandil (8.09 [95% CI: 3.20, 12.98] and 8.64 [95% CI: 3.28, 13.99], respectively). Thus this study suggests that short-term
therapy with
nicorandil is as effective as standard
therapy and that
nicorandil can also be used as a first-line agent in patients with
stable angina.