Trial reportCardiovascular drugs and therapy2015
Effect of Metformin on Renal Function After Primary Percutaneous Coronary Intervention in Patients Without Diabetes Presenting with ST-elevation Myocardial Infarction: Data from the GIPS-III Trial.
Trial report in Cardiovascular drugs and therapy, 2015. The graph read 4 numbers from its abstract, feeding 4 cells of the map: it finds no clear difference in 1. It also reports an association that does not count as treatment evidence, such as OR 3.30 (1.51 to 7.23) for adverse events & safety. Cited by 14 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
After adjustment for covariates, metformin treatment was not associated with CI-AKI (odds ratio: 0.96, 95%CI 0.52-1.75, P=0.88).
Read, but not usablea number the graph found but could not read as for or against
OR odds ratio, 95%CI 95 % confidence interval, TIMI thrombolysis in myocardial infarction, eGFR estimated glomerular filtration rate, CK creatine kinase, NT-proBNP N-terminal pro-B-type natriuretic peptide aDefined as Hb <13.7 mg/dl (<8.5 mmol/L) in men and Hb <12.1 mg/dl (<7.5 mmol/L) in women bCalculated using the Chronic Kidney Disease Epidemiology Collaboration study equation cLog transformed dIn total, coumarine derivatives were initiated in 19 (5.0 %) patients during hospitalization on clinical indication eIn total, mineralocorticoid receptor antagonists were initiated in 38 (10.0 %) patients during hospitalization on clinical indication Predictors for contrast-induced acute kidney injury When included in the multivariate analysis, contrast dose was not associated with the development of contrast-induced acute kidney injury (OR: 1.01 per 10 ml increase, 95%CI 0.98-1.03, P = 0.60).
CI-AKI contrast-induced acute kidney injury, ARB angiotensin-receptor blocker aIn addition to the study medication Multivariate logistic regression analysis identified the initiation of a MRA during hospitalization as the strongest predictor of CI-AKI (odds ratio (OR): 3.30, 95%CI 1.51-7.23, P < 0.01), as presented in Table 3.
When included in the multivariate analysis, contrast dose was not associated with the development of CI-AKI (OR: 1.01 per 10 ml increase, 95%CI 0.98-1.03, P = 0.60).Table 3Predictors for contrast-induced acute kidney injuryUnivariateMultivariateCharacteristicOR (95%CI) P-value OR (95%CI) P-value Randomization to metformin1.07 (0.61-1.88)0.820.96 (0.52-1.75)0.88Age (per 5 years increase)1.08 (0.95-1.21)0.241.31 (1.14-1.55)<0.01Female sex1.67 (0.91-3.07)0.10Ischemia time (per 5 mins increase)1.01 (1.00-1.02)<0.01Anemiaa 0.73 (0.34-1.57)0.42Pre-intervention TIMI-flow0.79 (0.62-1.01)0.06Contrast dose (per 5 ml increase)1.02 (1.00-1.05)0.07Length of procedure (per 5 mins increase)1.05 (0.99-1.13)0.13eGFRb (per 5 ml/min/1.72 m2 increase)1.12 (1.01-1.24)0.031.33 (1.14-1.55)<0.01CK (per 10 U/L increase)1.01 (1.00-1.02)<0.01Myocardial band of CK (per 5 U/L increase)1.03 (1.01-1.06)<0.01NT-proBNPc 2.08 (1.28-3.38)<0.011.91 (1.10-3.32)0.02Initiation of a coumarin derivative during hospitalizationd 3.70 (1.39-9.86)<0.01Initiation of a MRA during hospitalizatione 3.60 (1.72-7.57)<0.013.30 (1.51-7.23)<0.01When included in the multivariate analysis, contrast dose was not associated with the devel
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Where it lands on the map
Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.
What it adds to each cell
For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.
Metformin×kidney outcomes
InconclusiveOpen on the map →What to test next →1 readable study in this cell: 0 favour the treatment, 1 find no difference, 0 favour the comparator.
Antihypertensives×cardiovascular events
No readable resultOpen on the map →What to test next →1 readable study in this cell: 1 favour the treatment, 0 find no difference, 0 favour the comparator.
This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.
Antihypertensives×adverse events & safety
No readable resultOpen on the map →What to test next →No other readable study in this cell yet. This paper is the evidence.
Metformin×adverse events & safety
No readable resultOpen on the map →What to test next →22 readable studies in this cell: 9 favour the treatment, 8 find no difference, 5 favour the comparator.
This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 4 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Systematic review and meta-analysis of current guidelines, and their evidence base, on risk of renal function after administration of contrast medium for diabetic patients receiving metformin.Frontiers in medicine · 2025Pooled it
- Renal Complications after Percutaneous Coronary Interventions on Concurrent Metformin Therapy: A Systematic Review with Meta-Analysis.Clinical medicine & research · 2023Pooled it
- Continuous use of metformin in patients receiving contrast medium: what is the evidence? A systematic review and meta-analysis.European radiology · 2022Pooled it
- Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis.Cardiology · 2022Pooled it
- Safety of metformin continuation in diabetic patients undergoing invasive coronary angiography: the NO-STOP single arm trial.Cardiovascular diabetology · 2023Trial
- Alprostadil protects type 2 diabetes mellitus patients treated with metformin from contrast-induced nephropathy.International urology and nephrology · 2017Trial
- Impact of continuation of metformin prior to elective coronary angiography on acute contrast nephropathy in patients with normal or mildly impaired renal functions.Anatolian journal of cardiology · 2017 · on this mapTrial
- Temporal Course of Plasma Trimethylamine N-Oxide (TMAO) Levels in ST-Elevation Myocardial Infarction.Journal of clinical medicine · 2021Article
- Use of Anti-Diabetic Agents in Non-Diabetic Kidney Disease: From Bench to Bedside.Life (Basel, Switzerland) · 2021Review
- Metformin Preconditioning and Postconditioning to Reduce Ischemia Reperfusion Injury in an Isolated Ex Vivo Rat and Porcine Kidney Normothermic Machine Perfusion Model.Clinical and translational science · 2021Article
- Increasing metformin concentrations and its excretion in both rat and porcine ex vivo normothermic kidney perfusion model.BMJ open diabetes research & care · 2020Article
- Effect of continuous use of metformin on kidney function in diabetes patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.BMC cardiovascular disorders · 2020Article
- Article
- Association between physical activity and change in renal function in patients after acute myocardial infarction.PloS one · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The marked sentences are the ones the graph read a number from.
purposeThe association between metformin use and renal function needs further to be elucidated since data are insufficient whether metformin affects renal function in higher risk populations such as after ST-elevation myocardial infarction (STEMI).
methodsWe studied 379 patients included in the GIPS-III trial in which patients without diabetes or renal dysfunction, who underwent primary percutaneous coronary interventions (PCI) for STEMI, were randomized to metformin 500 mg or placebo twice daily for four months. At baseline and at seven scheduled visits up to four months after PCI, estimated glomerular filtration rate (eGFR) was determined (2582 values). Contrast-induced acute kidney injury (CI-AKI) was defined as an increase in serum creatinine of ≥0.3 mg/dl or 25 % rise within 48 h after PCI.
resultsAt all visits, the mean eGFR was similar in patients randomized to metformin or placebo. Over the four month period, mixed-effect repeated-measures model analysis showed a least-squares mean ± standard error change in eGFR of -5.9±0.8 ml/min/1.73 m2 in the metformin group and −7.1 ±0.8 ml/min/1.73 m2 in the control group (P=0.27 for overall interaction). The incidence of CI-AKI was 14.8 %; 29 (15.2 %) patients in the metformin group versus 27 (14.4 %) controls (P=0.89). After adjustment for covariates, metformin treatment was not associated with CI-AKI (odds ratio: 0.96, 95%CI 0.52−1.75, P=0.88).
conclusionWe conclude that initiation of metformin shortly after primary PCI has no adverse effect on renal function in patients without diabetes or prior renal impairment, further providing evidence of the safety of metformin use after myocardial infarction and subsequent contrast exposure.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.