Recently researchers from the Dept. of Internal Medicine published an article in The Lancet Diabetes & Endocrinology about the effect of the glucose-lowering drug metformin on myocardial injury during coronary artery bypass surgery in patients without diabetes (MetCAB).
During coronary artery bypass graft (CABG) surgery, ischaemia and reperfusion damage myocardial tissue, and an increased postoperative plasma troponin concentration, a biomarker for myocardial damage, is associated with worse outcome. Various animal studies have consistently reported that metformin reduces myocardial infarct size by limiting ischemia-reperfusion injury. They now investigated for the first time in humans whether metformin can limit cardiac injury in humans by performing a double-blinded randomized controlled trial in patients scheduled for CABG. Patients were pretreated with metformin or placebo for three days before surgery. Myocardial damage was measured with the postoperative plasma troponin concentration. In addition, myocardial tissue was harvested to investigate whether metformin actives prosurvival proteins.
The authors conclude that, although metformin activates pivotal prosurvival proteins in myocardial tissue, this does not translate into a reduced postoperative troponin concentration.
Short-term metformin pretreatment, therefore does not seem to be an effective strategy to reduce periprocedural myocardial injury in patients without diabetes undergoing CABG surgery.
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