title: Metformin and contrast-induced acute kidney injury in diabetic patients treated with primary percutaneous coronary intervention for ST segment elevation myocardial infarction: Amulticenter study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  In this multicenter observational study, chronic metformin treatment prior to primary PCI had no significant impact on CI-AKI.
authors.affiliation: Laboratoire de Physiopathologie et Pharmacologie Cardiométaboliques, INSERM U866, Université de Bourgogne Franche-Comté, France. Electronic address: Marianne.zeller@u-bourgogne.fr.
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.affiliation: Diabétologie Endocrinologie Nutrition, DHU FIRE, Hôpital Bichat, APHP, INSERM U1138, Centre de Recherche des Cordeliers, Université Paris Diderot, Paris, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Labalette-Bart
authors.affiliation: Cardiologie, DHU FIRE, Hôpital Bichat, APHP, INSERM U-1148, Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Juliard
authors.affiliation: Diabétologie Endocrinologie Nutrition, DHU FIRE, Hôpital Bichat, APHP, INSERM U1138, Centre de Recherche des Cordeliers, Université Paris Diderot, Paris, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Potier
authors.affiliation: Cardiologie, DHU FIRE, Hôpital Bichat, APHP, INSERM U-1148, Paris, France.
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Feldman
authors.affiliation: Cardiologie, DHU FIRE, Hôpital Bichat, APHP, INSERM U-1148, Paris, France.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Cardiologie, CHU Dijon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.affiliation: Diabétologie Endocrinologie Nutrition, DHU FIRE, Hôpital Bichat, APHP, INSERM U1138, Centre de Recherche des Cordeliers, Université Paris Diderot, Paris, France.
authors.forename: Ronan
authors.initials: R
authors.lastname: Roussel
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D003404:Creatinine / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D054539:Medication Therapy Management; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013223:Statistics as Topic
chemical_list: D003287:Contrast Media; D007004:Hypoglycemic Agents; D008687:Metformin; D003404:Creatinine
keywords: Acute kidney injury; Metformin; Primary percutaneous coronary intervention; ST segment elevation segment myocardial infarction