Background
Ref. | Subjects | Study design | Number of subjects | Median follow-up | Effect of metformin on blood glucose levels | Effect of metformin on endpoints |
---|---|---|---|---|---|---|
3 | Obese (BMI >27 kg/m2) patients with diabetes | Post-hoc analysis of RCT | 753 | 10.7 years | Comparable to other strategies | Improved survival (p = 0.021) |
4 | STEMI patients with diabetes | Post-hoc analysis of RCT | 1,145 | 4.1 years | Comparable to other strategies | Improved survival (HR death: 0.65, 0.47–0.90, p = 0.01) |
5 | Patients with diabetes undergoing coronary intervention | Post-hoc analysis of RCT | 2,772 | 9 months | Higher blood glucose levels compared to other strategies | Improved survival (OR death: 0.41, 0.21–0.79, p = 0.008) |
Lower rates of MI (OR MI: 0.41, 0.20–0.84, p = 0.016) | ||||||
6 | Patients with diabetes and atherothrombosis | Observational | 19,691 | 2 years | Higher blood glucose levels compared to other strategies | Improved survival (HR death: 0.76, 0.65–0.89, p < 0.001) |
7 | Elderly patients with diabetes and heart failure | Retrospective | 16,417 | 1 year | No data on glycemic control | Improved survival (HR death: 0.86, 0.78–0.97) |
8 | Patients with diabetes and heart failure | Observational | 6,185 | 2 years | No data on glycemic control | Improved survival (HR death: 0.76, 0.63–0.92, p < 0.001) |
9 | Patients with type 2 diabetes | Meta-analysis | 96,295 | 1.3 years | No data on glycemic control | No increased risk for lactic acidosis |
No differences in lactate levels |
Mechanism of action and potential benefit
Study design
Eligibility
Inclusion criteria | Exclusion criteria |
---|---|
• The diagnosis acute MI defined by chest pain suggestive for myocardial ischemia for at least 30 min, the time from onset of the symptoms less than 12 h before hospital admission, and an ECG recording with ST- segment elevation of more than 0.1 mV in 2 or more leads | • Prior MI |
• Diabetes | |
• Creatinin >177 μmol/L measured pre-PCI | |
• Need for coronary artery bypass grafting | |
• Rescue PCI after thrombolytic therapy | |
• Successful primary PCI <12 h from onset of symptoms | • When subjects develop a condition which, in the investigator’s judgment, precludes study therapy |
• Verbal followed by written informed consent | • Inability to provide informed consent |
• At least one stent sized ≥3.0 mm | • Younger than 18 years |
• Eligible for cardiac MRI-scan: | • Contra-indication to metformin |
- Body Mass Index <40 kg/m2
| • an estimated life-expectancy of less than 6 months |
- no ferromagnetic metal objects in the body | |
- no claustrophobia |