The effect of metformin on patient outcome after acute myocardial infarction

Date of Approval
Application Number
15_161
Technical Summary

The objective of the proposed research is to investigate the effect of preadmission and subsequent metformin on outcomes after acute myocardial infarction (AMI) in type 2 diabetics using CPRD data linked with the national audit of myocardial infarction (MINAP), Office for National Statistics (ONS) mortality data and hospital episode statistics (HES) data through the CALIBER dataset.

This is a prospective cohort study of patients with type 2 diabetes experiencing their first AMI, comparing patients with a prescription of metformin (or metformin and other oral anti-diabetic agents) versus alternative oral anti-diabetic medication without metformin prior to, and after, index AMI. Patients will be compared with respect to primary outcomes of major adverse cardiac events (a composite of cardiovascular death, acute coronary syndrome requiring hospitalisation, and stroke), heart failure and all-cause mortality.

The absolute incidence of AMI, demographic and baseline characteristics of the study population with or without metformin will be compared using the Pearson Chi Square test for categorical variables and Student t test for continuous variables.

We will calculate Kaplan-Meier product limits for cumulative probability of reaching an end point and use the log rank test for evidence of a significant difference between groups. Cox regression analysis will be used to estimate hazard ratios for the effect of metformin in fully adjusted models.

Collaborators

Derek Yellon - Chief Investigator - University College London ( UCL )
Daniel Bromage - Corresponding Applicant - King's College London (KCL)
Emily Herrett - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Harry Hemingway - Collaborator - University College London ( UCL )
Mar Pujades Rodriguez - Collaborator - University of Leeds
Xavier Rossello Lozano - Collaborator - University College London ( UCL )

Linkages

HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Patient Level Townsend Score;Practice Level Index of Multiple Deprivation;MINAP