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Rev Esp Cardiol (Engl Ed). 2018 Nov;71(11):917-925. doi: 10.1016/j.rec.2017.12.005. Epub 2018 Feb 1.

In Vivo Evaluation of the Synergic Effect of Metformin and mTOR Inhibitors on the Endothelial Healing of Drug-eluting Stents in Diabetic Patients.

[Article in English, Spanish]

Author information

1
Departamento de Cardiología Intervencionista, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
2
Departamento de Cardiología Intervencionista, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: rafaromaguera@gmail.com.
3
Departamento de Cardiología Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain.
4
Departamento de Cardiología Intervencionista, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
5
Departamento de Estadística, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
6
Departamento de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain.
7
Departamento de Endocrinología, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), L'Hospitalet de Llobregat, Barcelona, Spain.
8
Departamento de Cardiología Intervencionista, Hospital Universitario de La Princesa, Madrid, Spain.

Abstract

INTRODUCTION AND OBJECTIVES:

Recent animal studies have shown metformin (MF) to impair endothelialization of drug-eluting stents (DES). The aim of this study was to evaluate the effect of MF on the healing of DES in human coronary arteries of patients with diabetes mellitus by optical coherence tomography (OCT).

METHODS:

The RESERVOIR trial randomized 116 lesions in 112 patients with diabetes mellitus to amphilimus- or everolimus-eluting stents and included mandatory OCT at 9 months of follow-up. Patients were divided in 3 groups according to the glucose-lowering agents received: a) no MF; b) MF in noninsulin treated patients, and c) MF in insulin-treated patients. The primary safety endpoint was the rate of uncovered stents.

RESULTS:

Seventeen patients with 19 lesions did not receive MF, whereas MF was administered to 53 noninsulin treated patients (54 lesions) and 28 insulin-treated patients (28 lesions). Baseline characteristics were comparable, although noninsulin treated patients who received MF had better glycemic control (P < .01). By OCT, rates of uncovered struts were comparable between groups (3.07±4.80% vs 2.23±4.73% vs 3.43±6.69%, respectively; P = .48). Multivariate models confirmed that MF had no effect on the healing of DES (OR, 1.49, 95%CI, 0.71-3.08; P = .29). Similarly, quantitative angiography showed no effect of MF on late lumen loss, whereas patients treated with exogenous insulin had greater late lumen loss (P = .02).

CONCLUSIONS:

Metformin use does not impair endothelial healing of DES in patients with both insulin- and noninsulin-treated diabetes mellitus. According to these results, MF should not be discouraged in these patients.

KEYWORDS:

Diabetes mellitus; Drug-eluting stents; Metformin; Metformina; Stents farmacoactivos

PMID:
29396233
DOI:
10.1016/j.rec.2017.12.005

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