Is Routine Metformin Discontinuation Necessary Before Elective Coronary Angiography? A Randomized Clinical Trial
Abstract
Abstract Background: The optimal peri-procedural management of metformin in patients with type 2 diabetes undergoing elective coronary angiography remains debated. Concerns regarding contrast-induced acute kidney injury (CI-AKI) and the potential risk of metformin-associated lactic acidosis (MALA) have led to varying clinical practices, despite evolving evidence. Furthermore, limited data exist regarding the influence of metformin dosage and baseline renal function on post-procedural renal and metabolic outcomes. This randomized clinical trial aimed to evaluate the safety of continuing metformin therapy during elective coronary angiography and to assess the impact of metformin dose and pre-procedural renal status on subsequent laboratory changes.
Methods:: In this prospective, open-label randomized study, 204 adults with type 2 diabetes receiving metformin and scheduled for elective coronary angiography at Heshmat Hospital, Rasht, Iran, were randomly assigned to either continue metformin therapy (n = 102) or discontinue metformin 24 hours before the procedure with resumption 72 hours afterward (n = 102). Serum creatinine, estimated glomerular filtration rate (eGFR), plasma lactate concentration, and arterial pH were assessed at baseline and 72 hours following angiography. Between-group comparisons were conducted using appropriate statistical tests. Multivariable regression analysis was performed to adjust for baseline laboratory values, metformin dose, contrast volume, age,…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 204 participants or records.
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