Does Metformin have an effect on Stent Patency Rates
Pavel Kibrik, DO, Tereza Izakovich, BS, Jesse Victory, DO, Matthew A. Goldstein, MA, Christina M. Monteleone, BS, Ahmad Alsheekh, MD, Anil Hingorani, MD, Enrico Ascher, MD.
Vascular Institute of New York, brooklyn, NY, USA.
Objective(s): Today, metformin is considered to be the first-choice drug and is considered the "gold standard" for most people with type 2 diabetes. Metformin is the most commonly used diabetic medication used worldwide. Metformin use in patients with CHF, moderate CKD, or CLD with hepatic impairment is associated with improvements in mortality. Research has shown that metformin also has a protective effect on endothelium by decreasing endothelial vascular reactivity. We hypothesize that metformin will decrease re-stenosis/re-intervention rates in patients receiving lower extremity arterial stents.
Methods: A retrospective study was performed on 187 patients from October 2012 to December 2015 who received an arterial stent in the SFA and/or popliteal artery. Patients were further broken down into three groups: non-diabetics, diabetics not on metformin and diabetics on metformin and compared against each other for duplex based re-stenosis(>60%) rates, limb loss rates, and re-intervention rates. Patients smoking statuses were also taken into account, and patients were classified as current, former or non-smokers. Post-op duplex checks were performed one week after the procedure, then every three months for the first year after the procedure, followed by once every six months to check for patency. Fisher exact test, one-way ANOVA, Chi-square test, and multivariate logistical analysis were performed for statistical analysis.
Results: The average length of follow-up was 13. 3 +/- 9. 6 months. Of the patients (50) who were on metformin and diabetic, 24 had no re-stenosis, 34 had no re-intervention 26 had re-stenosis, and 16 had re-intervention. Of the patients who were diabetic but not on metformin (43), 27 had no re-stenosis, 32 had no re-intervention, 16 had re-stenosis, and 11 had re-intervention. Of the patients who did not have diabetes (94), 57 had no re-stenosis, 64 had no re-intervention, 37 had re-stenosis, and 30 had re-intervention. No patients experienced limb loss. There were no statistically significant differences between any of the three groups and their limb loss, re-stenosis, or re-intervention rates. Patients smoking status also had no effect on outcomes.
Conclusions: Despite having multiple proven effects in improving certain clinical outcomes and a proven protective effect on endothelium by decreasing endothelial vascular reactivity, metformin does not appear to reduce re-stenosis or re-intervention rates in patients receiving lower extremity arterial stents.
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