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

• Published in: Cardiovascular diabetology 2023-02, Vol.22 (1), p.28-28, Article 28
• Main 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
• Format: Article
• Language: English
• Subjects: Acidosis; Acidosis, Lactic - chemically induced; Acidosis, Lactic - diagnosis; Acute Kidney Injury - chemically induced; Acute Kidney Injury - diagnosis; Angiography; Antidiabetics; Blood; Cardiovascular disease; Consortia; Coronary angiography; Coronary Angiography - adverse effects; Creatinine; Diabetes; Diabetes mellitus; Diabetes Mellitus - chemically induced; Glomerular filtration rate; Heart attacks; Hemodialysis; Humans; Hypoglycemic Agents - adverse effects; Kidney diseases; Laboratories; Lactates; Lactic acid; Lactic acidosis; Medical imaging; Metformin; Metformin - adverse effects; Metformin-associated lactic acidosis; Mortality; Patients; Percutaneous coronary intervention; Prospective Studies; Renal function; Thrombosis
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-023-01744-4

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. 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. 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. 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. The study was registered at Clinicaltrials.gov (NCT04766008).