Metformin in Diabetic Patients Undergoing Coronary Angiography

NCT ID: NCT04766008

Last Updated: 2022-04-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-01-15

Study Completion Date

2022-04-30

Brief Summary

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The present study aims to evaluate the strict application of the 2018 European Society of Cardiology guidelines on myocardial revascularization, that recommends to check renal function if patients have taken metformin immediately before angiography and withhold metformin if renal function deteriorates.

The aim of this study is to assess the safety of metformin in diabetic patients undergoing coronary angiography in terms of risk of lactic acidosis and to individuate eventual predictors of augmented lactate after coronary angiography.

Detailed Description

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The study is designed as an open-label (both physician and participant know that metformin will not be discontinued before PCI and in the following 48 hours), prospective, single arm study.

In our historical cohort of diabetic patients taking metformin, we observed a mean value of lactate of 1.2+0.7 mmol/l.

A total of 150 patients will be enrolled. Patients with any deviations from the study protocol will be enrolled in a parallel observational registry.

The study consists of a screening phase, a 30-day observational phase, and an end-of-follow-up visit or phone interview. The total duration of participation in the study for each participant is approximately 30 days.

Conditions

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Diabetes Mellitus Coronary Artery Disease Lactic Acidosis With Diabetes Mellitus Contrast-induced Nephropathy Metformin Associated Lactic Acidosis

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Metformin continuation

Group Type EXPERIMENTAL

Metformin

Intervention Type DRUG

Diabetic patients treated with metformin undergoing coronary angiography will not suspend metformin before and after PCI.

Interventions

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Metformin

Diabetic patients treated with metformin undergoing coronary angiography will not suspend metformin before and after PCI.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Diabetic patients treated with metformin undergoing coronary angiography.

Exclusion Criteria

* Known coronary anatomy with planned complex percutaneous coronary intervention with high probability of large amount of contrast use (3.7 \* estimated glomerular filtration rate; e.g.: 167 ml in a patients with an eGFR of 45 ml/min/1.73m2).
* Moderate to severe impairment of renal function (eGFR\<45 ml/min).
* Moderate to severe impairment of liver function (Child-Pugh class B or C).
* Severely impaired left ventricular ejection fraction (LVEF \<35%).
* Patients undergoing primary percutaneous coronary intervention (i.e., patients presenting with ST elevation myocardial infarction).
* Severe to very severe chronic obstructive pulmonary disease (GOLD class 3 to 4).
* Patients scheduled for cardiac surgery in the following 5 days.
* Inability to provide informed consent.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Humanitas Hospital, Italy

OTHER

Sponsor Role lead

Responsible Party

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Giulio Stefanini

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Humanitas Research Hospital

Rozzano, Milan, Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Giulio Stefanini, MD, PhD

Role: CONTACT

+390282247384

Mauro Chiarito, MD

Role: CONTACT

+390282247009

Facility Contacts

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Giulio Stefanini, Prof

Role: primary

0282247384

References

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Pfisterer ME, Zellweger MJ. Therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009 Oct 1;361(14):1407; author reply 1409-10. doi: 10.1056/NEJMc091419. No abstract available.

Reference Type BACKGROUND
PMID: 19797290 (View on PubMed)

Bailey CJ, Turner RC. Metformin. N Engl J Med. 1996 Feb 29;334(9):574-9. doi: 10.1056/NEJM199602293340906. No abstract available.

Reference Type BACKGROUND
PMID: 8569826 (View on PubMed)

Maznyczka A, Myat A, Gershlick A. Discontinuation of metformin in the setting of coronary angiography: clinical uncertainty amongst physicians reflecting a poor evidence base. EuroIntervention. 2012 Jan;7(9):1103-10. doi: 10.4244/EIJV7I9A175.

Reference Type BACKGROUND
PMID: 21959259 (View on PubMed)

Timmer JR, Ottervanger JP, de Boer MJ, Dambrink JH, Hoorntje JC, Gosselink AT, Suryapranata H, Zijlstra F, van 't Hof AW; Zwolle Myocardial Infarction Study Group. Hyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2005 Apr 5;45(7):999-1002. doi: 10.1016/j.jacc.2004.12.050.

Reference Type BACKGROUND
PMID: 15808754 (View on PubMed)

Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. Reply. N Engl J Med. 2019 Sep 26;381(13):1296-1297. doi: 10.1056/NEJMc1908879. No abstract available.

Reference Type BACKGROUND
PMID: 31553855 (View on PubMed)

Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Juni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention. 2019 Feb 20;14(14):1435-1534. doi: 10.4244/EIJY19M01_01. No abstract available.

Reference Type BACKGROUND
PMID: 30667361 (View on PubMed)

Parra D, Legreid AM, Beckey NP, Reyes S. Metformin monitoring and change in serum creatinine levels in patients undergoing radiologic procedures involving administration of intravenous contrast media. Pharmacotherapy. 2004 Aug;24(8):987-93. doi: 10.1592/phco.24.11.987.36131.

Reference Type BACKGROUND
PMID: 15338847 (View on PubMed)

Nawaz S, Cleveland T, Gaines PA, Chan P. Clinical risk associated with contrast angiography in metformin treated patients: a clinical review. Clin Radiol. 1998 May;53(5):342-4. doi: 10.1016/s0009-9260(98)80005-6.

Reference Type BACKGROUND
PMID: 9630271 (View on PubMed)

Laskey WK, Jenkins C, Selzer F, Marroquin OC, Wilensky RL, Glaser R, Cohen HA, Holmes DR Jr; NHLBI Dynamic Registry Investigators. Volume-to-creatinine clearance ratio: a pharmacokinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention. J Am Coll Cardiol. 2007 Aug 14;50(7):584-90. doi: 10.1016/j.jacc.2007.03.058. Epub 2007 Jul 30.

Reference Type BACKGROUND
PMID: 17692741 (View on PubMed)

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 Feb 6;22(1):28. doi: 10.1186/s12933-023-01744-4.

Reference Type DERIVED
PMID: 36747244 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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20190918

Identifier Type: -

Identifier Source: org_study_id

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