- NEWS . 20 Apr 2020
Metformin continuation after primary PCI not associated with increased risk of contrast-induced acute kidney injury
In patients with diabetes and ST-segment elevation myocardial infarction (STEMI), the continuous use of metformin after primary percutaneous coronary intervention (PCI) remains controversial because of an increased risk of contrast-induced acute kidney injury (CI-AKI). Therefore, researchers sought to assess the effect of continuous metformin therapy on kidney function in patients with diabetes undergoing PCI.
The study population consisted of 284 patients with metformin-treated diabetes, who had an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2 at baseline. Of these, 119 patients continued metformin treatment after primary PCI, while 165 patients discontinued it after 48 hours post-PCI. Serum creatinine level was measured at baseline and within 48 hours post-PCI as a determinant of CI-AKI.
There was no statistical difference in CI-AKI incidence between the continuous and discontinuous metformin groups (12.6% vs 10.3%; p=0.545). The researchers found that eGFR ≤60 mL/min/1.73 m2 (p=0.025; odds ratio [OR], 3.131; 95% confidence interval [CI], 1.156–8.482) and contrast volume (p=0.002; OR, 1.010; 95% CI, 1.004–1.016) were predictive factors of CI-AKI, and that metformin therapy was irrelevant to CI-AKI (p=0.365; OR, 0.698; 95% CI, 0.320–1.521). No case of lactic acidosis was reported. Additionally, the study findings indicated that discontinuation of metformin was not beneficial for patients' blood glucose control after admission.
The study concluded that metformin continuation after primary PCI for STEMI in patients with diabetes and impaired kidney function did not increase the risk of CI-AKI.
Yu Q, et al. Effect of continuous use of metformin on kidney function in diabetes patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. BMC Cardiovasc Disord 2020;20:187.