Observational studyCardiovascular diabetology2026

Prognostic impact of metformin in diabetic patients undergoing a percutaneous coronary intervention (PCI): protective effect is modified by procedural complexity.

Zhihao Zheng, Ziyi Wang, Jining He, Yanjun Song, Weihua Song, Kefei Dou

Abstract readObservational Study
In one paragraph

Observational study in Cardiovascular diabetology, 2026. The graph read 3 numbers from its abstract, feeding 2 cells of the map, but none could be read as for or against, so it casts no vote. It also reports an association that does not count as treatment evidence, such as HR 0.80 (0.70 to 0.92) for cardiovascular events. Cited by 1 paper.

3numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from 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.

Read, but not usablea number the graph found but could not read as for or against

Cardiovascular eventscomparator not stated · ascvd, t2dfeeds 2 cells of the map
HR 0.650.53 to 0.79
Significantly lower incidence of MACCEs was observed in patients undergoing non-complex PCI (adjusted HR 0.65, 95% CI: 0.53-0.79), while such protective effect of metformin didn’t exist in complex PCI patients (adjusted HR 1.00, 95%CI: 0.83-1.21).
Cardiovascular eventsan association or prognostic statement, not a treatment comparison · ascvd, t2dfeeds one cell of the map
HR 0.800.70 to 0.92
Overall, metformin use was observed to be associated with a lower incidence of 3-year MACCEs (adjusted HR 0.80, 95%CI 0.70-0.92) after multivariable adjustment.
Cardiovascular eventscomparator not stated · ascvd, t2dfeeds 2 cells of the map
HR 1.000.83 to 1.21
Significantly lower incidence of MACCEs was observed in patients undergoing non-complex PCI (adjusted HR 0.65, 95% CI: 0.53-0.79), while such protective effect of metformin didn’t exist in complex PCI patients (adjusted HR 1.00, 95%CI: 0.83-1.21).

clause the extractor read what became the number

2 · Its place on the map

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.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

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.

Cardiac procedures & devices×cardiovascular events

No readable resultOpen on the map →What to test next →

3 readable studies in this cell: 2 favour the treatment, 0 find no difference, 1 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Metformin×cardiovascular events

No readable resultOpen on the map →What to test next →

5 readable studies in this cell: 4 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.50contested · 4 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

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.

5 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Observational
6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

6 authors.

Zhihao ZhengCardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, 100037, Beijing, China.
Ziyi WangCardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, 100037, Beijing, China.
Jining HeCardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, 100037, Beijing, China.
Yanjun SongCardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, 100037, Beijing, China.
Weihua SongCardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, 100037, Beijing, China. songweihua926@163.com.
Kefei DouCardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, 100037, Beijing, China. drdoukefei@126.com.

Funding

Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CIFMS) 2023‑I2M‑C&T‑B‑055
8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundMetformin, a widely prescribed glucose-lowering agent, has demonstrated cardiovascular benefits in patients with diabetes who do not have established atherosclerotic cardiovascular disease. However, evidence regarding its role specifically in patients with diabetes undergoing percutaneous coronary intervention (PCI) remains limited. This study therefore aimed to evaluate the prognostic association of metformin use in this high‑risk population and to explore its potential interaction with procedural complexity.

methodsFrom January 2017 to December 2018, 11,585 diabetic patients undergoing PCI at Fuwai hospital were consecutively enrolled in our study. Patients were categorized into four groups according to metformin use and PCI complexity. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, non-fatal myocardial infarction (MI), non-fatal stroke, and unplanned revascularization.

resultsAfter a follow-up of 3 years, a total of 1292 MACCEs were recorded. Overall, metformin use was observed to be associated with a lower incidence of 3-year MACCEs (adjusted HR 0.80, 95%CI 0.70–0.92) after multivariable adjustment. Significantly lower incidence of MACCEs was observed in patients undergoing non-complex PCI (adjusted HR 0.65, 95% CI: 0.53–0.79), while such protective effect of metformin didn’t exist in complex PCI patients (adjusted HR 1.00, 95%CI: 0.83–1.21). Significant interaction between metformin and PCI complexity was found with regard to the 3-year MACCE rate (Pinteraction = 0.003; adjusted Pinteraction = 0.002).

conclusionsIn this observational study, there was significant difference in the efficacy of metformin in diabetic patients undergoing complex or non-complex PCI. Metformin use was associated with improved prognosis in patients with diabetes undergoing non-complex PCI.

Indexed as

Coronary Artery DiseaseDiabetes MellitusHypoglycemic AgentsMetforminPercutaneous Coronary InterventionAgedChinaFemaleHumansMaleMiddle AgedProtective FactorsRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsHypoglycemic AgentsMetforminDiabetesMetforminPercutaneous coronary interventionPrognosis

Identifiers

PMID41691210
PMCPMC12980892

What Socratic holds

Texttitle and abstract
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.