Randomized Comparison of Metformin Continuation Versus Interruption Following Coronary Angiography/Angioplasty

Shavadia, Jay; Minhas, Rajan; Orvold, Jason; Basran, Rashpal; Wells, Christine; Devilliers, Jacobus; Pearce, Colin; Eckstein, Janine; Mangipudi, R.; Haddad, Haissam

doi:10.1016/j.jcin.2021.10.029

Cited by 2 publications

(8 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of note, preprocedural lactate levels, hydration amount, and the prevalence of known risk factors for CA-AKI (e.g., anemia and reduced left ventricular ejection fraction) were not reported. Lastly, the trials planned to enrol 500 patients, but the coronavirus disease-19 pandemic forced the authors to prematurely stop the enrolment [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, the discontinuation of metformin could imply delay in coronary angiography and result in poor glycemic control, which in turn increases the risk of cardiovascular events and contrast-associated acute kidney injury (CA-AKI) [ 10 ]. A number of observational and randomized studies comparing metformin continuation versus interruption before and following coronary angiography/PCI reported no differences in M-ALA, CA-AKI, serum lactate and bicarbonate levels, or short-term mortality [ 11 , 12 ]. However, these studies were not powered to detect a clinically relevant difference in the risk of M-ALA or CA-AKI and did not report preprocedural lactate levels.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…25,28 Our analysis provides information on (a) in the remaining 1159 patients. There were five randomized clinical trials, 26,27,[30][31][32] (one 32 in non-diabetic patients), two retrospective, 28,29 and two prospective 24,25 cross-sectional cohort studies, conducted in Europe, Asia, Canada, and the United States between the years 2010 and 2020. Seven studies 24,26,27,[29][30][31][32] enrolled patients without severe renal impairment, whereas no such entry criteria were set in the remaining two studies.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, 719 studies were further excluded either because the participants did not undergo coronary angiography, or because data on concurrent drug regimen, renal function, or MALA were absent (Figure 1). The remaining nine studies [24][25][26][27][28][29][30][31][32] (one 31 accessed through ClinicalTrials.gov) were included in the analysis.…”

Section: Study Selectionmentioning

confidence: 99%

“…A total of nine studies with a population of 2,235 patients were included in the analysis; eight [24][25][26][27][28][29][30][31] were conducted in diabetic patients and one 32 in non-diabetic patients. Of the total cohort, 1076 patients underwent PCI while treated with metformin during peri-procedural period, whereas metformin was absent coronary syndromes, irrespective of the diagnosis of diabetes.…”

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Renal Complications after Percutaneous Coronary Interventions on Concurrent Metformin Therapy: A Systematic Review with Meta-Analysis

2023

View full text Add to dashboard Cite

Objective: Metformin, commonly prescribed in diabetic patients, can cause lactic acidosis. Although generally rare, this side effect remains a source of concern in procedures requiring contrast media, due to the risk of contrast-induced nephropathy. Temporarily withdrawing metformin during the peri-procedural period is often practiced, but clinical decisions are difficult in emergency situations, such as acute coronary syndromes. In this systematic review with meta-analysis, we aimed to further investigate the safety of percutaneous coronary interventions in patients on concurrent metformin therapy. Design, Setting and Participants:We analyzed studies in patients undergoing (elective or emergency) percutaneous coronary interventions with or without concurrent metformin administration, reporting on the incidence of metformin-associated lactic acidosis and peri-procedural renal function.Methods: PubMed, ClinicalTrials.gov, Cochrane Library, and Scopus were systematically searched without language restrictions throughout August 2022. Randomized clinical trials and observational studies were assessed with the Revised Cochrane Collaboration Risk of Bias tool and the Newcastle-Ottawa quality scale, respectively. Data synthesis addressed the mean drop in estimated glomerular filtration rate (eGFR) and the incidence of contrast-induced nephropathy, in addition to lactic acidosis.Results: Nine studies were included, totaling 2235 patients (1076 continuing metformin during the peri-procedural period), mostly with eGFR above 30 mL/min/1.73m 2 . No cases of lactic acidosis were reported. The mean post-procedural drop in eGFR was 6.81mL/min/1.73m 2 (95% confidence interval [CI]: 3.41 to 10.21) in the presence of metformin and 5.34 mL/min/1.73m 2 (95% CI: 2.98 to 7.70) in its absence. The incidence of contrast-induced nephropathy was not affected by concurrent metformin, as shown by a (between-groups) standardized mean difference of 0.0007 (95%

show abstract

Randomized Comparison of Metformin Continuation Versus Interruption Following Coronary Angiography/Angioplasty

Cited by 2 publications

References 3 publications

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

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

Renal Complications after Percutaneous Coronary Interventions on Concurrent Metformin Therapy: A Systematic Review with Meta-Analysis

Contact Info

Product

Resources

About