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

 -  2023 
<br/><br/>Available online through MWHC library: 2002 - present 
<br/><br/> 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.  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.  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.  TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov (NCT04766008). Copyright © 2023. The Author(s). 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1475-2840 
<br/><br/><label>Standard No.: </label>10.1186/s12933-023-01744-4 [doi] 10.1186/s12933-023-01744-4 [pii] PMC9902064 [pmc] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Acidosis, Lactic<br/>*Acute Kidney Injury<br/>*Diabetes Mellitus<br/>*Metformin<br/>Acidosis, Lactic/ci [Chemically Induced]<br/>Acidosis, Lactic/di [Diagnosis]<br/>Acute Kidney Injury/ci [Chemically Induced]<br/>Acute Kidney Injury/di [Diagnosis]<br/>Coronary Angiography/ae [Adverse Effects]<br/>Diabetes Mellitus/ci [Chemically Induced]<br/>Humans<br/>Hypoglycemic Agents/ae [Adverse Effects]<br/>Lactates<br/>Metformin/ae [Adverse Effects]<br/>Prospective Studies
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Heart & Vascular Institute
<br/><br/><label>Index Terms--Function: </label><br/>Clinical Trial<br/>Journal Article<br/>Multicenter Study<br/>Research Support, Non-U.S. Gov't