Effect of continuous use of metformin on kidney function in diabetes patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Qi, Yu; Zhu, Jiajia; Liu, Wenxian

doi:10.1186/s12872-020-01474-5

Cited by 13 publications

(14 citation statements)

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“…Furthermore, the full texts of 74 articles were reviewed, and 21 articles that did not meet the eligibility criteria were excluded. Out of the 26 full-text articles reviewed, 7 studies were able to meet our eligibility criteria on associations between metformin and CI-AKI (Table 1 ) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. These studies comprised 2,325 individuals, with 279 new cases of CI-AKI exposed to CM.…”

Section: Resultsmentioning

confidence: 99%

Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis

Huang

et al. 2022

Cardiology

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Background: The published researches regarding the use of contrast media(CM) in patients taking metformin were very scarce.we conducted a systematic review and meta-analysis to explore the relationship between metformin and contrast-induced acute kidney injury(CI-AKI). Methods: We conducted comprehensive search for literature on associations between MAC and AF using the following databases: MEDLINE, PubMed, Embase, and the Web of Science. The pooled odds ratio (OR) or relative risk and the corresponding 95% confidence intervals (CIs) were calculated to assess the relationship between metformin and CI-AKI, as well as the incidence of lactic acidosis(LA). Results: 7 studies met our eligibility criteria on associations between metformin and CI-AKI, consisting of 2,325 individuals, including 279 cases of new CI-AKI patients during CM exposure. The pooled analysis demonstrated no statistically elevated risk of development CI-AKI in patients with uninterrupted use of metformin (Random-effects OR: 1.15, 95%CI: 0.70, 1.90; P =0.57). No cases of LA occurred during CM exposure. Conclusion: Metformin can be safely applied in patients with moderate renal impairment as low as eGFR ≥30 ml/min/1.73 m2 during the exposure of the CM.

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Section: Resultsmentioning

confidence: 99%

Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis

Huang

et al. 2022

Cardiology

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“…Проведенное исследование продемонстрировало, что применение метформина до госпитализации не сопровождалось увеличением риска развития ОПП после проведения ангиографии: ОР 0,85 (0,37–1,96), p=0,691. Полученный результат согласуется с недавними публикациями других авторов [ 18 ]. Во-вторых, применение метформина за пределами первых 48 ч после ЧКВ не сопровождалось повышением уровня лактата и клинически значимыми изменениями показателей pH и BE.…”

Section: Discussionunclassified

Use of metformin in patients with type 2 diabetes and acute myocardial infarction: safety and impact on glycemic control

Коротина

Починка

Стронгин

2023

Probl Endokrinol (Mosk)

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BACKGROUND: Myocardial infarction (MI) in patients with diabetes type 2 (T2DM) occurs 1.5–3.0 times higher than in general population. Metformin is contraindicated for patients with T2DM and acute coronary syndrome due to the risk of developing lactic acidosis. Using metformin more than 48 hours of MI is a topical question, which will help to improve patient’s safety.AIM: To evaluate the safety and quality of glycemic control using metformin in patients with T2DM during inpatient treatment for MIMATERIALS AND METHODS: The study included 161 patients with T2DM, who were hospitalized consecutively with acute MI with ST-elevation and underwent percutaneous coronary intervention (PCI). Average time of metformin initiation was 5th day from admission. Creatinine was assessed at admission and 48 hours after PCI. The acid-base balance and lactate were assessed at admission and on the 3rd day after the start of using metformin. Criteria for the effectiveness of glycemic control was the proportion of glycemic measurements in target range of 6.1–10.0 mmol/l during hospitalization (“hospital time in range”, hTIR). hTIR >55% was considered to be a critical level. The long-term outcome was estimated at 365 days after hospitalization.RESULTS: Metformin was prescribed to 99 patients (61%) (“M+”group) during the hospitalization, 62 patients were in “M-”group. Use of metformin was accompanied with better glycemic control in the «M+» group compared to the «M-»: mean glycemia 9.3 ± 1.6 vs 10.3 ± 2.3 mmol/l (p=0,002), SD 2.87 ± 1.1 vs 3.26 ± 1.8 (p=0,049), hTIR 60 ± 18% vs 48 ± 23% (p<0,001). There were clinically insignificant changes in acid-base balance on the 3rd day from the start of metformin use in the “M+” group, the lactate level did not increase. Use of metformin before to hospitalization with MI was not associated with an increased risk of developing acute kidney injury (AKI): RR 0.85 (0.37–1.96), p=0,691.CONCLUSION: Use of metformin in patients with T2DM and acute MI is associated with better glycemic control. Carrying out angiography in patients, treated with metformin before the hospitalization, is not accompanied by an increased risk of developing AKI. Appointment of metformin in 3–7 days after angiography does not lead to an increase level of lactate and significant deviations in acid-base balance.

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“…A prespecified analysis from the GIPS-III trial, which randomized non-diabetic patients without renal impairment presenting with ST elevation myocardial infarction to metformin or placebo early after primary PCI [30], did not show any increase in the risk of CA-AKI with metformin [12]. Similarly, other observational and randomized studies focused on diabetic patients without severe renal impairment showed that metformin continuation before and after angiography is not associated with higher risk of CA-AKI or M-ALA as compared with metformin discontinuation [9,31]. Most of the available evidence, however, is affected by several bias or potential confounders.…”

Section: Glycemic Control and Adverse Events In Patients Undergoing C...mentioning

confidence: 95%

Safety of metformin continuation in diabetic patients undergoing invasive coronary angiography: the NO-STOP single arm trial

Chiarito

Sanz‐Sánchez

Piccolo

et al. 2023

Cardiovasc Diabetol

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Background Despite paucity of data, it is common practice to discontinue metformin before invasive coronary angiography due to an alleged risk of Metformin-Associated Lactic Acidosis (M-ALA). We aimed at assessing the safety of metformin continuation in diabetic patients undergoing coronary angiography in terms of significant increase in lactate levels. Methods In this open-label, prospective, multicentre, single-arm trial, all diabetic patients undergoing coronary angiography with or without percutaneous coronary intervention at 3 European centers were screened for enrolment. The primary endpoint was the increase in lactate levels from preprocedural levels at 72-h after the procedure. Secondary endpoints included contrast associated-acute kidney injury (CA-AKI), M-ALA, and all-cause mortality. Results 142 diabetic patients on metformin therapy were included. Median preprocedural lactate level was 1.8 mmol/l [interquartile range (IQR) 1.3–2.3]. Lactate levels at 72 h after coronary angiography were 1.7 mmol/l (IQR 1.3–2.3), with no significant differences as compared to preprocedural levels (p = 0.91; median difference = 0; IQR − 0.5 to 0.4 mmol/l). One patient had 72-h levels ≥ 5 mmol/l (5.3 mmol/l), but no cases of M-ALA were reported. CA-AKI occurred in 9 patients (6.1%) and median serum creatinine and estimated glomerular filtration rate remained similar throughout the periprocedural period. At a median follow-up of 90 days (43–150), no patients required hemodialysis and 2 patients died due to non-cardiac causes. Conclusions In diabetic patients undergoing invasive coronary angiography, metformin continuation throughout the periprocedural period does not increase lactate levels and was not associated with any decline in renal function. Trial registration: The study was registered at Clinicaltrials.gov (NCT04766008). Graphical Abstract

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Effect of continuous use of metformin on kidney function in diabetes patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Cited by 13 publications

References 50 publications

Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis

Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis

Use of metformin in patients with type 2 diabetes and acute myocardial infarction: safety and impact on glycemic control

Safety of metformin continuation in diabetic patients undergoing invasive coronary angiography: the NO-STOP single arm trial

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