Metformin Continuation Versus Holding Pre and Post Coronary Angiography with Normal Renal Function: A Systematic Review and Meta-Analysis

Authors

Mohammad Hamza, Albany Medical CenterFollow
Yasar Sattar, West Virginia UniversityFollow
Sadaf Fakhra, University of Nevada Las Vegas Kirk Krikorian School of Medicine, NV, USAFollow
Neel Patel, New York Medical College/ Landmark Medical CenterFollow
Mubashar Karamat, King Edward Medical UniversityFollow
Saman RazzaqFollow
Aamir Saeed, Merit Health Wesley hospitalFollow
Khaled M. Harmouch, Detroit Medical Center-Wayne State UniversityFollow
Islam Elgendy, Gill Heart Institute, University of KentuckyFollow
Mamas Mamas, manchester heart centreFollow
Anand Prasad, ut health science center san antonioFollow
Wael AlJaroudi, Medical College of Georgia at Augusta UniversityFollow
Ramesh Daggubati, West Virginia University,Follow
M Chadi AlraiesFollow

Abstract

Background

It is common practice to withhold metformin prior to cardiac catheterization due to fear of developing lactic acidosis in the setting of contrast-associated acute kidney injury (AKI). The evidence behind this recommendation is currently weak.

Methods

We collected 851 articles from PubMed and Embase, of which 3 met our inclusion criteria. Inclusion criteria were age > 18 years, baseline use of long-term metformin with continued or interrupted metformin use in patients during diagnostic or interventional cardiac catheterization. The outcomes studied were differences between post-catheterization and pre-catheterization serum creatinine (SCr) and glomerular filtration rate (GFR). We excluded studies dealing with patients not on long-standing metformin and those in which contrast exposure was through contrast enhanced computerized tomography. We used Hedges’s g with inverse variance method to pool standard mean difference with a random effects model using meta-cont module in CRAN-R software with 95% confidence interval (CI) for statistical significance. Higgins I-squared (I²) statistic was used to evaluate heterogeneity.

Results

. Post-catheterization serum creatinine (Hedges’s g = -0.12 mg/dL; CI = -0.83 to +0.6, p = 0.75, I² = 95%), post-catheterization GFR (Hedges’s g = +0.18 mL/min; CI = -0.76 to +1.11, p = 0.71, I² = 97%) and post-catheterization lactate levels (Hedges’s g = +0.03 mg/dL; CI = -0.66 to +0.72, p = 0.75, I² = 95%) failed to reach statistical significance.

Conclusions

There is no statistically significant difference in SCr or GFR between patients who held metformin prior to cardiac catheterization and those who continued taking the medication.

Recommended Citation

Hamza M, Sattar Y, Fakhra S, Patel N, Karamat M, Razzaq S, Saeed A, Harmouch KM, Elgendy I, Mamas M, Prasad A, AlJaroudi W, Daggubati R, Alraies M. Metformin Continuation Versus Holding Pre and Post Coronary Angiography with Normal Renal Function: A Systematic Review and Meta-Analysis. Transformative Medicine. 2024; 3(1):1-15. doi: https://doi.org/10.54299/tmed/blxr6776.