0116: Metformin and contrast-induced nephropathy in diabetic patients treated with primary percutaneous coronary intervention for ST segment elevation myocardial infarction: a multicentre study

Abstract

Contrast-induced nephropathy (CIN) is a frequent complication in patients undergoing percutaneous coronary intervention (PCI), associated with increased mortality. The impact of metformin, which has potential interactions with renal function, on CIN remains to be investigated. To analyze the association between chronic metformin treatment and the development of CIN after primary PCI for ST segment elevation myocardial infarction (STEMI). 372 patients with diabetes mellitus (DM) treated with PCI <24H in 2 coronary care units (Paris-Bichat and Dijon Hospital, France) were included. Serum creatinine (Cr) was measured before and 48H after PCI. CIN was defined as an increase in Cr of 44µmol/L (0.5 mg/dL) or 25% over baseline after PCI. Since PCI was urgent, metformin could not be withheld prior to PCI but was usually stopped after PCI. Mean age was 66±11 y, and 25% were women. 64% had hypertension, 56% had DM duration >5 year, and 26% had prior coronary artery disease. Metformin and sulfonylurea were the most frequently used antidiabetic chronic treatments (40% for both), and 27% were on insulin therapy. The other antidiabetic medications, including glinide, glitazone, and acarbose were rarely used (3%, 2%, and 5%, respectively). Mean baseline and post PCI Cr levels were 102±52 and 122±81µmol/L. Rate of CIN was similar in patients with or without metformin (21 vs 20%, respectively, p= 0.87). Logistic regression for the risk of CIN taking into account classical risk factors showed no impact of chronic metformin therapy, even in stratified analysis in patients with chronic kidney disease. Hospital mortality was similar between groups (7 vs 6%, respectively, p=0.69). Moreover, no case of lactic acidosis was reported during the hospital stay. In this multicentre study reflecting current clinical practice, metformin treatment prior to primary PCI had no significant impact on CIN. Larger studies are needed to confirm these findings.