American Heart Journal
Volume 154, Issue 1 , Pages 144-150, July 2007

Effect of thiazolidinedione therapy on restenosis after coronary stent implantation: A meta-analysis of randomized controlled trials

  • Evangelos S. Rosmarakis, MD

      Affiliations

    • Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
    • Department of Cardiology, First IKA Hospital, Athens, Greece
    • ,
  • Matthew E. Falagas, MD, MSc, DSc

      Affiliations

    • Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
    • Department of Medicine, Tufts University School of Medicine, Boston, MA
    • Corresponding Author InformationReprint requests: Matthew E. Falagas, MD, MSc, DSc, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece.

Received 19 December 2006; accepted 1 April 2007. published online 11 May 2007.

Background

We sought to review the evidence from the available randomized controlled trials (RCTs) regarding the effect of thiazolidinedione therapy on in-stent restenosis after percutaneous coronary intervention.

Methods

The studies in our meta-analysis were retrieved from search on the PubMed database and from references in relevant articles. Included studies were RCTs that provided comparative data regarding the effectiveness of 6-month pioglitazone or rosiglitazone therapy on the prevention of in-stent restenosis after coronary stent implantation as assessed by quantitative coronary angiography.

Results

Five RCTs that included 235 evaluable patients who underwent coronary stent implantation and received a 6-month pioglitazone or rosiglitazone therapy were included in our meta-analysis. Restenosis rate was significantly lower in patients who received thiazolidinedione therapy in addition to standard therapy (3 RCTs, 170 patients, odds ratio 0.29, 95% CI 0.15-0.56, random effects model). Percentage diameter stenosis was significantly lower in the pioglitazone-rosiglitazone arm (3 RCTs, 170 patients, weighted difference in means 14.35, 95% CI 19.99-8.72, random effects model). Minimal lumen diameter of the target lesion was significantly higher in patients who received thiazolidinedione therapy (3 RCTs, 170 patients, weighted difference in means 0.43, 95% CI 0.21-0.65, random effects model). Patients who received thiazolidinediones were significantly less likely to undergo target lesion revascularization due to restenosis (4 RCTs, 197 patients, odds ratio 0.24, 95% CI 0.09-0.61, random effects model).

Conclusions

Our study suggests that thiazolidinedione therapy in patients undergoing coronary stent implantation may be associated with less in-stent restenosis and repeated revascularization. Decisions on clinical use of this therapy must await larger double-blind clinical trials.

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PII: S0002-8703(07)00283-9

doi:10.1016/j.ahj.2007.04.005

American Heart Journal
Volume 154, Issue 1 , Pages 144-150, July 2007

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