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Chronic Metformin Treatment is Associated with Reduced Myocardial Infarct Size in Diabetic Patients with ST-segment Elevation Myocardial Infarction

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Abstract

Purpose

Increased myocardial infarct (MI) size is associated with higher risk of developing left ventricular dysfunction, heart failure and mortality. Experimental studies have suggested that metformin treatment reduces MI size after induced ischaemia but human data is lacking. We aimed to investigate the effect of metformin on MI size in patients presenting with an acute MI.

Methods

All consecutive patients (n = 3,288) presenting to our hospital with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI between January 2004 and December 2010 were included in this retrospective analysis. Patients with diabetes were divided according to metformin versus non-metformin based pharmacotherapy. MI size was estimated using peak values of serum creatine kinase (CK), myocardial band of CK (CK-MB), and troponin-T.

Results

We identified 677 (20.6 %) patients with diabetes, of whom 189 (27.9 %) were treated with metformin. Chronic metformin treatment was associated with lower peak levels of CK (1,101 vs. 1,422 U/L, P = 0.005), CK-MB (152 vs. 182 U/L, P = 0.018) and troponin-T (2.5 vs. 4.0 ng/L, P = 0.021) compared to non-metformin using diabetics. After adjustment for age, sex, TIMI flow post PCI, and previous MI, the use of metformin treatment remained an independent predictor of smaller MI size. Patient with diabetes treated with metformin had even smaller MI size than patients without diabetes.

Conclusions

Chronic metformin treatment is associated with reduced MI size compared to non-metformin based strategies in diabetic patients presenting with STEMI. Metformin might have additional beneficial effects beyond glucose lowering efficacy.

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Funding Source

This study was supported by grant 95103007 from ZonMW, the Netherlands Organization for Health Research and Development, The Hague, the Netherlands.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, PO Box 30.001, Groningen, The Netherlands

    Chris P. H. Lexis, Wouter G. Wieringa, Bart Hiemstra, Vincent M. van Deursen, Erik Lipsic, Pim van der Harst, Dirk J. van Veldhuisen & Iwan C. C. van der Horst

  2. Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Iwan C. C. van der Horst

Authors
  1. Chris P. H. Lexis
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  2. Wouter G. Wieringa
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  3. Bart Hiemstra
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  4. Vincent M. van Deursen
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  5. Erik Lipsic
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  8. Iwan C. C. van der Horst
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Correspondence to Chris P. H. Lexis.

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Lexis, C.P.H., Wieringa, W.G., Hiemstra, B. et al. Chronic Metformin Treatment is Associated with Reduced Myocardial Infarct Size in Diabetic Patients with ST-segment Elevation Myocardial Infarction. Cardiovasc Drugs Ther 28, 163–171 (2014). https://doi.org/10.1007/s10557-013-6504-7

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