Effect of thiazolidinedione therapy on restenosis after coronary stent implantation: A meta-analysis of randomized controlled trials
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.
aAlfa Institute of Biomedical Sciences (AIBS), Athens, Greece
bDepartment of Cardiology, First IKA Hospital, Athens, Greece
cDepartment of Medicine, Tufts University School of Medicine, Boston, MA
Reprint requests: Matthew E. Falagas, MD, MSc, DSc, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece.
ABSTRACT