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- Title
Safety of metformin continuation in diabetic patients undergoing invasive coronary angiography: the NO-STOP single arm trial.
- Authors
Chiarito, Mauro; Sanz-Sanchez, Jorge; Piccolo, Raffaele; Condello, Francesco; Liccardo, Gaetano; Maurina, Matteo; Avvedimento, Marisa; Regazzoli, Damiano; Pagnotta, Paolo; Garcia-Garcia, Hector M.; Mehran, Roxana; Federici, Massimo; Condorelli, Gianluigi; Diez Gil, Jose Luis; Reimers, Bernhard; Ferrante, Giuseppe; Stefanini, Giulio
- Abstract
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).
- Subjects
CORONARY angiography; PEOPLE with diabetes; PERCUTANEOUS coronary intervention; METFORMIN; MYOCARDIAL perfusion imaging; GLOMERULAR filtration rate
- Publication
Cardiovascular Diabetology, 2023, Vol 22, Issue 1, p1
- ISSN
1475-2840
- Publication type
Article
- DOI
10.1186/s12933-023-01744-4