Objective:

To investigate whether the addition of nicorandil to dihydropyridine calcium channel blockers (DHP-CCBs) can lower 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, a total of 7,413 eligible CHD patients were classified into DHP-CCBs plus nicorandil combination (n = 1,843) and DHP-CCBs (n = 5,570) 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 was associated with a reduced risk of MACE (HR: 0.80, 95% CI: 0.67–0.97). The combination group also experienced a reduced 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 disclosed that the benefits of the combined treatment on MACE were more pronounced in diabetic than in non-diabetic patients. 

 Conclusions: 

The combination of nicorandil and DHP-CCBs may be more beneficial than DHP-CCBs alone in reducing long-term risks of MACE and stroke in patients with CHD.