Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey.
Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2022 Sep;50(6):422-430. doi: 10.5543/tkda.2022.22430.
Discontinuation of metformin treatment is a frequently used approach in clinical practice in diabetic ST-segment elevation myocardial infarction patients using metformin in order to reduce the risk of contrast-induced acute kidney injury. There is insufficient evidence in the literature to support this approach. The aim of this study is to determine whether the risk of contrast-induced acute kidney injury is different in diabetic ST-segment elevation myocardial infarction patients using metformin compared to those not taking metformin.
The population of the study consisted of patients who applied to our centers that are covered by this study with the diagnosis of ST-segment elevation myocardial infarction and underwent primary percutaneous intervention between 2014 and 2019. Three forty-three diabetic patients that met the study inclusion criteria were divided into 2 groups as who have been receiving metformin and who have not. Patients' creatinine values at admission and peak creatinine values were compared in order to determine whether they have developed contrastinduced acute kidney injury. The 2 groups were compared using conditional logistic regression analysis conducted with the inverse probability weighting method.
Non-weighted classic multivariable logistic regression analysis revealed that metformin use was not associated with acute kidney injury. Weighted conditional multivariable logistic regression revealed that the increase in the risk of acute kidney injury was associated with baseline creatinine levels [odds ratio: 1.49 (1.06-2.10; 95% CI) P=.02] and that the increase in the risk of contrast-induced acute kidney injury was not associated with metformin usage [odds ratio: 0.92 (0.57-1.50, 95% CI) P=.74].
No statistically significant difference was found between the metformin and nonmetformin users among the diabetic ST-segment elevation myocardial infarction patients who underwent primary percutaneous intervention in the risk of contrast-induced acute kidney injury.
在使用二甲双胍的糖尿病 ST 段抬高型心肌梗死患者中，为降低对比剂诱导的急性肾损伤风险，常停用二甲双胍治疗。但文献中缺乏支持这种方法的充分证据。本研究旨在确定与未使用二甲双胍的患者相比，使用二甲双胍的糖尿病 ST 段抬高型心肌梗死患者发生对比剂诱导的急性肾损伤的风险是否不同。
该研究的人群为 2014 年至 2019 年间在我院行直接经皮冠状动脉介入治疗且诊断为 ST 段抬高型心肌梗死的患者。符合研究纳入标准的 343 例糖尿病患者分为使用二甲双胍和未使用二甲双胍两组。比较患者入院时和峰值时的肌酐值，以确定是否发生对比剂诱导的急性肾损伤。使用逆概率加权法进行条件逻辑回归分析比较两组。
未加权经典多变量逻辑回归分析显示，二甲双胍的使用与急性肾损伤无关。加权条件多变量逻辑回归显示，基线肌酐水平与急性肾损伤风险增加相关[比值比：1.49（1.06-2.10；95%CI）P=0.02]，而对比剂诱导的急性肾损伤风险的增加与二甲双胍的使用无关[比值比：0.92（0.57-1.50，95%CI）P=0.74]。
在接受直接经皮冠状动脉介入治疗的糖尿病 ST 段抬高型心肌梗死患者中，使用和未使用二甲双胍的患者在对比剂诱导的急性肾损伤风险方面无统计学差异。
