Effect of metformin on the incidence of contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention

Yu Qi; Zhu Jiajia; Liu Wenxian

doi:10.3760/j.issn.1673-4777.2020.04.003

Abstract：Objective To investigate the effect of metformin during perioperative period of primary percutaneous coronary intervention(PPCI) on contrast-induced nephropathy(CIN) in patients with acute myocardial infarction(AMI) and type 2 diabetes mellitus(T2DM). Methods A total of 283 patients with AMI and T2DM undergoing PPCI from January 2008 to December 2017 in Beijing Anzhen Hospital, Capital Medical University were included. Among them, 119 cases were treated with metformin routinely during perioperative period ( group A); 164 cases stopped taking metformin 72 h after operation ( group B ) . Cardiovascular risk factors ( age≥65 years, gender, course of diabetes≥5 years, hyperlipidemia, smoking, hypertension, peripheral arterial disease, prior myocardial infarction) , rates of left ventricular ejection fraction≤40％, contrast media volume≥300 ml, estimated glomerular filtration rate (eGFR)≤60 ml/(min·1. 73 m2), postoperative relative creatinine difference≥25％ and absolute creatinine difference≥44. 2μmol/L, medication during hospital stay, incidences of CIN and lactic acidosis, laboratory indicators( glycosylated hemoglobin, hemoglobin, peak cardiac troponin, baseline eGFR, baseline creatinine, postoperative creatinine, relative creatinine difference and absolute creatinine difference) were recorded. Risk factors of CIN were analyzed by logistic regression. Results Use rate of β-blockers in group A was higher and postoperative creatinine level was lower than those in group B[79. 8％(95/119) vs 59. 8％(98/164), 76.3(63.7,96.0)μmol/L vs 82.6(72.4,97.6)μmol/L](both P <0.05). No case of lactic acidosis was observed during hospitalization. No statistical significance was found between groups in cardiovascular risk factors, medication, incidence of CIN and other laboratory indicators(all P>0. 05). Logistic regression analysis showed that contrast media volume≥300 ml(odds ratio=3. 552, 95％CI: 1. 653-7. 631, P=0. 001) and hypertension (odds ratio=4.704, 95％CI: 1.165-18.994, P =0.030) were the risk factors of CIN. Conclusion In T2DM patients undergoing PPCI for AMI, continuous use of metformin dose not increase the incidence of CIN. However;patients with hypertension and using contrast media volume≥300 ml are associated with higher risk of CIN.