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GIPS-III: No effect of metformin on LV function after STEMI

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WASHINGTON — New data do not support the use of metformin to preserve left ventricular function in patients without diabetes presenting with ST-segment elevation MI.

At the American College of Cardiology Scientific Sessions, Chris P.H. Lexis, MD, presented findings from the GIPS-III study of 380 nondiabetic patients who underwent PCI for STEMI (median baseline age, 59 years). The patients were randomly assigned to receive twice-daily metformin 500 mg or placebo for 4 months in addition to standard of care according to the latest guidelines so researchers could examine the effect on LV function. Patients with known diabetes or those who needed CABG were excluded from the study.

At 4 months, there was no difference in LV ejection fraction measured by MRI between patients assigned metformin or placebo (53.1% vs. 54.8%; P=.0961). In addition, N-terminal pro-brain natriuretic peptide at 4 months following PCI was 167 ng/L in both groups (P=.66). Major adverse cardiac events occurred in 3.1% of the metformin group compared with 1.1% of the placebo group (P=.16).

Chris P.H. Lexis

All patients were alive at 4 months.

“Metformin is safe to use after STEMI,” Lexis, from University of Groningen in the Netherlands, said during the late-breaking clinical trials presentation. However, “the current results do not support the use of metformin in this setting.”
GIPS-III is the first double blind, randomized, placebo-controlled study to evaluate the effects of metformin on LV function in this patient population, the researchers said.

“This study did not prove the benefits of metformin in acute myocardial infarction and as such will not change clinical practice as we might have thought,” Lexis said in a press release. “However, it is noteworthy that metformin started early after heart attack did not adversely affect kidney function and was well tolerated.”

Creatinine concentration was 79 mcmol/L in both groups at follow-up (P=.61). Glycated hemoglobin was also similar between the groups (5.9% for both; P=.15). No cases of lactic acidosis occurred.

The researchers noted, however, that the results observed in the GIPS-III trial reflect metformin administration after PCI. Whether metformin can be administered before PCI or in higher doses than were studied remains to be explained. – by Katie Kalvaitis

For more information:

Lexis CPH. Joint American College of Cardiology/New England Journal of Medicine Late-Breaking Clinical Trials. Presented at: American College of Cardiology Scientific Sessions; March 29-31, 2014; Washington, D.C.

Lexis CPH. JAMA. 2014;doi:10.1001/jama.2014.3315.

Disclosure: The study was supported by a grant from ZonMw, the Netherlands Organization for Health Research and Development. Lexis reports no relevant financial disclosures.