Cardiovascular Disease Clinical Trial
Official title:
The Metformin in CABG (MetCAB) Trial
Rationale:
In patients with a myocardial infarction, occlusion of a coronary artery induces myocardial
ischemia and cell death. If untreated, the area of myocardium exposed to this interruption
in blood supply, will largely become necrotic. The only way to limit final infarct size, is
timely reperfusion of the occluded artery. Paradoxically, however, reperfusion itself can
also damage myocardial tissue and contribute to the final infarct size ("reperfusion
injury"). Also during coronary artery bypass grafting (CABG), the myocardium is exposed to
ischemia and reperfusion, which will induce cell death. Indeed, postoperatively, the plasma
concentration of troponin I, a marker of cardiac necrosis, is increased, and associated with
adverse outcome. The anti-hyperglycaemic drug metformin has been shown in preclinical
studies to be able to reduce ischemia-reperfusion injury and to limit myocardial infarct
size. Moreover, metformin therapy improves cardiovascular prognosis in patients with
diabetes mellitus. Paradoxically, in patients with diabetes, current practice is to
temporarily stop metformin before major surgery for the presumed risk of lactic acidosis,
which is a rare complication of metformin. However, here is no evidence that this practice
benefits the patient. The investigators hypothesize that pretreatment with metformin can
reduce myocardial injury in patients undergoing elective CABG surgery
n/a
Allocation: Randomized, Endpoint Classification: Pharmacodynamics Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Prevention
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