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Chiarito M, Sanz-Sanchez J, Piccolo R, Condello F, Liccardo G, Maurina M, Avvedimento M, Regazzoli D, Pagnotta P, Garcia-Garcia HM, Mehran R, Federici M, Condorelli G, Diez Gil JL, Reimers B, Ferrante G, Stefanini G. Safety of metformin continuation in diabetic patients undergoing invasive coronary angiography: the NO-STOP single arm trial. Cardiovasc Diabetol 2023; 22:28. [PMID: 36747244 PMCID: PMC9902064 DOI: 10.1186/s12933-023-01744-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
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).
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Affiliation(s)
- Mauro Chiarito
- grid.417728.f0000 0004 1756 8807Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Jorge Sanz-Sanchez
- grid.84393.350000 0001 0360 9602Hospital Universitario y Politécnico La Fe, Valencia, Spain ,grid.512890.7Centro de Investigación Biomedica en Red, Madrid, Spain
| | - Raffaele Piccolo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Condello
- grid.417728.f0000 0004 1756 8807Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gaetano Liccardo
- grid.417728.f0000 0004 1756 8807Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Matteo Maurina
- grid.417728.f0000 0004 1756 8807Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marisa Avvedimento
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Damiano Regazzoli
- grid.417728.f0000 0004 1756 8807Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Pagnotta
- grid.417728.f0000 0004 1756 8807Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Hector M. Garcia-Garcia
- grid.415235.40000 0000 8585 5745Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC USA
| | - Roxana Mehran
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Massimo Federici
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy ,grid.413009.fCenter for Atherosclerosis, Policlinico Tor Vergata, Rome, Italy
| | - Gianluigi Condorelli
- grid.417728.f0000 0004 1756 8807Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Jose Luis Diez Gil
- grid.84393.350000 0001 0360 9602Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Bernhard Reimers
- grid.417728.f0000 0004 1756 8807Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Ferrante
- grid.417728.f0000 0004 1756 8807Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulio Stefanini
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Jensen LO, Loh PH, Calmac L, Roura-Ferrer G, Quadros A, Milewski M, Scotto di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong ASL, Kala P, Diez Gil JL, Carrillo X, Dirksen MT, Becerra-Muñoz VM, Kang-Yin Lee M, Juzar DA, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld AO, Galasso G, Lux A, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac A, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Lozano Martìnez-Luengas I, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Fores J, Vignali L, Pereira H, Manzo-Silberman S, Ordonez S, Özkan AA, Scheller B, Lehtola H, Teles R, Mantis C, Ylitalo A, Brum Silveira JA, Zoni R, Bessonov I, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe C, Kanakakis J, Faurie B, Gabrielli G, Gutiérrez A, Bachini JP, Rocha A, Tam FC, Rodriguez A, Lukito A, Saint-Joy V, Pessah G, Tuccillo B, Cortese G, Parodi G, Bouraghda MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction. Heart 2022; 108:458-466. [PMID: 34711661 PMCID: PMC8561823 DOI: 10.1136/heartjnl-2021-319750] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). METHODS This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. RESULTS In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. CONCLUSION Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic. TRIAL REGISTRATION NUMBER NCT04412655.
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Affiliation(s)
- Giuseppe De Luca
- Department of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | | | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico, Centro PROCAPE Prof. Tavares, Recife, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, Kemerovo Cardiology Center, Кемерово, Russia
| | - Zan Zimbakov
- University Clinic for Cardiology, Ss Cyril and Methodius University in Skopje, Skopje, Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, Singapore Health Service, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital, University of Bucharest, Bucuresti, Romania
| | - Gerard Roura-Ferrer
- Interventional Cardiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Alexandre Quadros
- Instituto de Cardiologia, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil
| | - Marek Milewski
- Division of Cardiology, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Academisch Medisch Centrum, Twente, The Netherlands
| | | | - Jurriën Ten Berg
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | | | - Petr Kala
- University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Jose Luis Diez Gil
- Department of Cardiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Xavier Carrillo
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen ElizabethHospital University of Hong Kong, Hong Kong, Hong Kong
| | - Dafsah A Juzar
- Department of cardiology and Vascular Medicine, National Cardiovascular Center 'Harapan Kita', Jakarta, Indonesia
| | | | | | - Davor Milicic
- Department of Cardiology, University of Zagreb, Zagreb, Croatia
| | | | - Nikola Bakraceski
- Center for Cardiovascular Diseases, Ohrid University Hospital, Ohrid, Macedonia
| | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy
| | | | | | - Gennaro Galasso
- Division of Cardiology, University of Salerno, Salerno, Italy
| | - Arpad Lux
- Cardiology, Maastricht University Hospital, Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Ancona, Italy
| | | | - Maurizio Menichelli
- Cardiology Division, Ospedale Fabrizio Spaziani, Roma, Italy
- Cardiology Division, Ospedale "F. Spaziani", Frosinone, Italy
| | | | - Aylin Yamac
- Department of Cardiology, Bezmialem Vakıf University İstanbul, Istanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Eskisehir Osmangazi Universitesi, Eskisehir, Turkey
| | | | - Tomas Kovarnik
- Department of Cardiovascular Medicine, University Hospital Prague, Prague, Czech Republic
| | - Michal Kidawa
- Central Hospital, Medical University of Lodz, Lodz, Poland
| | - Jose Moreu
- Division of Cardiology, Hospital Complex of Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Lille University Hospital Center, Lille, France
| | - Enrico Fabris
- Department of Cardiology, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Naples, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Consorcio Sanitario de Tenerife, Santa Cruz de Tenerife, Spain
| | | | - Gianluca Caiazzo
- Division of Cardiology, Ospedale "G Moscati", Aversa, Aversa, Italy
| | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Juan Sanchis Fores
- Department of Cardiology, Hospital Clinico Universitario, Universidad de Valencia, Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Parma, Italy
| | - Helder Pereira
- Cardiology Department, Garcia de Orta Hospital, Almada, Portugal
| | | | - Santiago Ordonez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, Saarland University, Saarbrucken, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Rui Teles
- Department of Cardiology, Hospital de Santa Cruz, CHLO - Nova Medical School,CEDOC, Carnaxide, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, Athens, Athens, Greece
| | - Antti Ylitalo
- Division of Cardiology, Heart Centre Turku, Turku, Finland
| | | | - Rodrigo Zoni
- Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Argentina
| | | | | | | | | | - Carlos Uribe
- Division of Cardiology, Medellin Clinic Universidad UPB, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, General Hospital of Athens Alexandra, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gabriele Gabrielli
- SOD Cardiologia-Emodinamica-UTIC, Azienda Ospedali Riuniti - Presidio 'GM Lancisi', Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | - Franckie Cc Tam
- Department of Cardiology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Alfredo Rodriguez
- Department of Cardiology, Otamendi Hospital, Buenos Aires, Argentina
| | - Antonia Lukito
- Cardiovascular Department, Pelita Harapan University, Tangerang, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Cordoba Hospital, Cordoba, Argentina
| | | | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Guido Parodi
- Division of cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Elvin Kedhi
- Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Bruxelles, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Matteo Nardin
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Ospedali Riuniti, Brescia, Italy
| | - Monica Verdoia
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Cardiology, Nuovo Ospedale degli Infermi ASL Biella, Biella, italy
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