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Metformin Was Associated with Lower All-Cause Mortality in Type 2 Diabetes with Acute Coronary Syndrome: A Nationwide Registry with Propensity Score-Matched Analysis

24 Pages Posted: 8 Oct 2018

See all articles by Chien-Boon Jong

Chien-Boon Jong

National Taiwan University - Department of Internal Medicine

Chao-Lun Lai

National Taiwan University - Department of Internal Medicine; National Taiwan University - College of Medicine; National Taiwan University - Graduate Institute of Epidemiology and Preventive Medicine

Kuan-Yu Chen

ANSN Clinic - Department of Internal Medicine

Mu-Yang Hsieh

National Taiwan University - Department of Internal Medicine

Fang-Ying Su

National Taiwan University - National Taiwan University Hospital (NTUH)

Chih-Cheng Wu

National Taiwan University - National Taiwan University Hospital (NTUH); National Tsing Hua University - Institute of Biomedical Engineering; National Taiwan University - College of Medicine

Wen-Chol Voon

Kaohsiung Medical University

I-Chang Hsieh

Chang Gung University - Chang Gung Memorial Hospital

Kou-Gi Shyu

Shin Kong Wu Ho-Su Memorial Hospital

Jun-Ted Chong

Pingtung Christian Hospital

Wei-Shiang Lin

National Defense Medical Center - Tri-Service General Hospital

Chih-Neng Hsu

National Taiwan University - National Taiwan University Hospital (NTUH)

Kwo-Chang Ueng

Chung-Shan Medical University

More...

Abstract

Background: No randomized controlled trials evaluating metformin therapy efficacy in patients with type 2 diabetes mellitus (DM) and acute coronary syndrome (ACS) have been reported. Well-designed retrospective studies controlling for imbalance in baseline patient characteristics are scarce. We aimed to examine the mortality benefit of metformin therapy in patients with type 2 DM and ACS, compared with non-metformin anti-diabetes agent users.

Method: Data were extracted from the prospective nationwide ACS-DM Taiwan Society of Cardiology registry. Propensity score (PS) matching on baseline characteristics and treatment measures was performed for metformin versus non-metformin users. Cox proportional hazard models were used to compare mortality outcomes among the PS-matched cohort as a primary analysis. Traditional Cox proportional hazard models adjusting for all pre-determined covariates and quintiles of the PS among the overall population were performed as a secondary analysis.

Findings: Of 1157 patients with type 2 DM and ACS receiving anti-diabetes agents, 78 patients (6.7%) died over the 2-year follow-up period. After PS matching, 318 metformin users were matched with 318 non-metformin users. Metformin users had a lower all-cause mortality rate (adjusted hazard ratio [aHR] 0·50, 95% confidence interval [CI] 0·26-0·95) in the primary analysis. The survival benefit of metformin therapy was consistent in the secondary analyses (aHR 0·30, 95% CI 0·17-0·54 while adjusting for all pre-determined covariates, and aHR 0·34, 95% CI 0·19-0·59 while adjusting for quintiles of the PS).

Interpretation: Among patients with type 2 DM and ACS, metformin was associated with lower all-cause mortality.

Funding Statement: This work was supported with grants from the Hsin-Chu branch of the National Taiwan University Hospital (HCH-106036). The funding source also provided technical help (Biotechnology R&D Center) with data analysis and interpretation of the findings.

Declaration of Interest: All authors report no relationships that could be construed as a conflict of interest.

Ethics Approval Statement: Patients are treated according to international or local guidelines and evidence-based strategies. The protocol and consent forms used in this study were consistent with the Declaration of Helsinki and relevant regulations. The ethics committees of each participating hospital approved the study, and all enrolled patients provided written informed consent.

Keywords: metformin; diabetes mellitus; acute coronary syndrome; mortality

Suggested Citation

Jong, Chien-Boon and Lai, Chao-Lun and Chen, Kuan-Yu and Hsieh, Mu-Yang and Su, Fang-Ying and Wu, Chih-Cheng and Voon, Wen-Chol and Hsieh, I-Chang and Shyu, Kou-Gi and Chong, Jun-Ted and Lin, Wei-Shiang and Hsu, Chih-Neng and Ueng, Kwo-Chang, Metformin Was Associated with Lower All-Cause Mortality in Type 2 Diabetes with Acute Coronary Syndrome: A Nationwide Registry with Propensity Score-Matched Analysis (April 10, 2018). Available at SSRN: https://ssrn.com/abstract=3260794 or http://dx.doi.org/10.2139/ssrn.3260794

Chien-Boon Jong

National Taiwan University - Department of Internal Medicine

Taipei
Taiwan

Chao-Lun Lai (Contact Author)

National Taiwan University - Department of Internal Medicine ( email )

Taipei
Taiwan

National Taiwan University - College of Medicine ( email )

1 Sec. 4, Roosevelt Road
Taipei 106, 106
Taiwan

National Taiwan University - Graduate Institute of Epidemiology and Preventive Medicine

1 Sec. 4, Roosevelt Road
Taipei 106, 106
Taiwan

Kuan-Yu Chen

ANSN Clinic - Department of Internal Medicine

Hsin-Chu
Taiwan

Mu-Yang Hsieh

National Taiwan University - Department of Internal Medicine

Taipei
Taiwan

Fang-Ying Su

National Taiwan University - National Taiwan University Hospital (NTUH)

Taipei, 10048
Taiwan

Chih-Cheng Wu

National Taiwan University - National Taiwan University Hospital (NTUH)

Taipei, 10048
Taiwan

National Tsing Hua University - Institute of Biomedical Engineering

Hsin-Chu
Taiwan

National Taiwan University - College of Medicine

1 Sec. 4, Roosevelt Road
Taipei 106, 106
Taiwan

Wen-Chol Voon

Kaohsiung Medical University

No. 100, Shíquán 1st Rd
Kaohsiung City, Sanmin District
Taiwan

I-Chang Hsieh

Chang Gung University - Chang Gung Memorial Hospital

Taiwan

Kou-Gi Shyu

Shin Kong Wu Ho-Su Memorial Hospital

No. 95, Wenchang Road
Taipei City
Taiwan

Jun-Ted Chong

Pingtung Christian Hospital

No. 60, Dalian Road
Pingtung City
Taiwan

Wei-Shiang Lin

National Defense Medical Center - Tri-Service General Hospital

Taipei
Taiwan

Chih-Neng Hsu

National Taiwan University - National Taiwan University Hospital (NTUH)

Taipei, 10048
Taiwan

Kwo-Chang Ueng

Chung-Shan Medical University

Taichung City
Taiwan