Marianne Zeller1, Mathilde Labalette-Bart2, Jean-Michel Juliard3, Louis Potier2, Laurent J Feldman3, Philippe Gabriel Steg3, Yves Cottin4, Ronan Roussel2. 1. Laboratoire de Physiopathologie et Pharmacologie Cardiométaboliques, INSERM U866, Université de Bourgogne Franche-Comté, France. Electronic address: Marianne.zeller@u-bourgogne.fr. 2. Diabétologie Endocrinologie Nutrition, DHU FIRE, Hôpital Bichat, APHP, INSERM U1138, Centre de Recherche des Cordeliers, Université Paris Diderot, Paris, France. 3. Cardiologie, DHU FIRE, Hôpital Bichat, APHP, INSERM U-1148, Paris, France. 4. Cardiologie, CHU Dijon, France.
Abstract
AIM: To analyze the association between chronic metformin treatment and the development of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). METHODS: Patients with type 2 diabetes mellitus (T2DM) treated with PCI <24h in 2 coronary care units were included. Serum creatinine (Cr) was measured before and <48h after PCI. CI-AKI was defined as an increase in Cr>27μmol/l (0.3mg/dl) or >50% over baseline after PCI. Since PCI was urgent, metformin could not be withheld prior to PCI but was usually stopped after PCI. RESULTS: Among the 372 patients included, 147 (40%) were using metformin, which had older diabetes, but had risk factors similar to patients without metformin. Baseline eGFR was better in patients under metformin therapy. After PCI, we observed an increase of ≈10% in Cr, for both groups. There was a trend toward a lower rate of CI-AKI in patients under metformin (16% vs 25%, p=0.051). In patients with chronic kidney disease, 31 (26%) were under metformin therapy, and the rate of CI-AKI was similar in both groups (41% vs 40%, p=0.915). By multivariate analysis, metformin showed a trend toward a reduced rate of CI-AKI, even when adjusted for confounding (OR (95% CI): 0.548 (0.276-1.087)). No case of lactic acidosis was reported during the hospital stay. Moreover, there was no increased rate of cardiogenic shock or death with metformin treatment. CONCLUSION: In this multicenter observational study, chronic metformin treatment prior to primary PCI had no significant impact on CI-AKI.
AIM: To analyze the association between chronic metformin treatment and the development of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). METHODS:Patients with type 2 diabetes mellitus (T2DM) treated with PCI <24h in 2 coronary care units were included. Serum creatinine (Cr) was measured before and <48h after PCI. CI-AKI was defined as an increase in Cr>27μmol/l (0.3mg/dl) or >50% over baseline after PCI. Since PCI was urgent, metformin could not be withheld prior to PCI but was usually stopped after PCI. RESULTS: Among the 372 patients included, 147 (40%) were using metformin, which had older diabetes, but had risk factors similar to patients without metformin. Baseline eGFR was better in patients under metformin therapy. After PCI, we observed an increase of ≈10% in Cr, for both groups. There was a trend toward a lower rate of CI-AKI in patients under metformin (16% vs 25%, p=0.051). In patients with chronic kidney disease, 31 (26%) were under metformin therapy, and the rate of CI-AKI was similar in both groups (41% vs 40%, p=0.915). By multivariate analysis, metformin showed a trend toward a reduced rate of CI-AKI, even when adjusted for confounding (OR (95% CI): 0.548 (0.276-1.087)). No case of lactic acidosis was reported during the hospital stay. Moreover, there was no increased rate of cardiogenic shock or death with metformin treatment. CONCLUSION: In this multicenter observational study, chronic metformin treatment prior to primary PCI had no significant impact on CI-AKI.
Authors: Rene A Posma; Leonie H Venema; Tobias M Huijink; Andrie C Westerkamp; A Mireille A Wessels; Nynke J De Vries; Frank Doesburg; J Roggeveld; Petra J Ottens; Daan J Touw; Maarten W Nijsten; Henri G D Leuvenink Journal: BMJ Open Diabetes Res Care Date: 2020-08