Abstract 11554: Is Metformin Treatment Hazardous in Diabetic Patients with AMI Undergoing Coronary Angiography?
Background: current guidelines recommend stopping metformin two days before coronary angiography or PCI. However, there is very little evidence to support this recommendation.
Aim: to assess in-hospital outcomes in diabetic patients with AMI undergoing coronary angiography/PCI at the acute stage, according to the use of metformin before the acute episode.
Results: of 1316 diabetic patients with AMI in the FAST-MI nationwide French prospective registry carried out over a 2-month period in 2005, 1076 underwent coronary angiography at the acute stage, among whom 411 (38%) were receiving metformin. Patients on metformin (Met +) were slightly younger (67 ± 10 vs 68 ± 12 years, P=0.02), had more history of hypertension (77% vs 71%, P<0.05, less history of previous CABG 5% vs 10%, P=0.001, and less frequently received insulin before the AMI 14% vs 33%, P<0.001)); 47% of both groups had STEMI. Admission glycemia was similar (208 ± 84 vs 206 ± 100 mg/dL) but creatinin was lower in the Met+ group (94 ± 30 vs 116 ± 94 µmol/L, P<0.001). Complications were either similar or lower in the Met+ group: in-hospital death (2.7 vs 4.8%, adjusted OR=0.89; 95%CI 0.20-3.98), major bleeding or transfusion (4.6 vs 5.0%; adjusted OR=1.01; 95%CI: 0.32-3.14), any complication (10.7 vs 17.6%, adjusted OR=0.62; 95%C: 0.40-0.96, P<0.05). Similar findings were observed in the patients who had undergone primary PCI or those with coronary angiography <24 hours of admission. Two cohorts (with or without metformin before AMI) were matched on admission creatinin; again, metformin was associated with a similar mortality (OR =0.60; 95%CI: 0.06-5.73) and lower overall complication rate (OR=0.59; 95%CI: 0.37-0.96, P=0.03). Cox-adjusted 3-year combined hazard of mortality, reinfarction or stroke was lower in Met+ patients (HR=0.77; 95%CI: 0.60-1.00).
Conclusion: uninterrupted metformin treatment in patients undergoing coronary angiogaphy/PCI for AMI was not associated with increased hazard. Current guidelines might deserve to be revisited.
- © 2011 by American Heart Association, Inc.