IONA study (Impact Of Nicorandil in Angina)

• the IONA study compared nicorandil (titrated to 20mg twice daily) with placebo in 5,126 high-risk patients with stable angina
• all patients required further antianginal treatment at recruitment and took the study drug in addition to optimised standard antianginal therapy
• IONA revealed that fewer patients in the nicorandil group experienced the combined primary end-point of coronary heart disease (CHD) death, non-fatal MI or unplanned admission to hospital with cardiac chest pain (13.1% vs.15.5%; relative risk 0.83, 95% CI 0.72-0.97; mean follow-up 1.6 years). The main benefit for the group treated with nicorandil was a reduction in unplanned admission, because there was no difference between nicorandil and placebo in the combined secondary endpoint of CHD death or nonfatal MI

Notes:

• the IONA study only assessed the role of nicorandil as an 'add-on' therapy
• the data from the IONA study would suggest that nicorandil may be a worthwhile add-on therapy (number needed to treat 42 for 1.6 years for the primary combined endpoint) for certain patients considered to be at high risk of a cardiovascular event (e.g. 66% of patients in IONA had a previous MI)
• in the IONA study nicorandil was used with various combinations of antianginals including beta-blockers, calcium channel blockers and long-acting nitrates - therefore the IONA study does not provide information as to when to add in nicorandil

Reference:

1. The IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact of Nicorandil in Angina (IONA) randomised trial. Lancet 2002, 359:1269-75.