Pioglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with type 2 diabetes mellitus: an intravascular ultrasound scanning study.
BACKGROUND
It has been reported that pioglitazone reduces neointimal hyperplasia after balloon-induced vascular injury in an experimental model.


METHODS
To determine whether pioglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with type 2 diabetes mellitus, we studied 44 stented lesions in 44 patients with diabetes mellitus who underwent successful coronary stent implantation. Study patients were randomized into 2 groups: the pioglitazone group (23 patients with 23 lesions) and the control group (21 patients with 21 lesions). All patients underwent serial quantitative coronary angiography and serial intravascular ultrasound scanning studies. With a motorized pullback system, multiple image slices within the stent were obtained at every 1 mm. The stent area and lumen area were measured, and the neointimal area was calculated. Measurements were averaged over the number of selected image slices. The neointimal index was calculated as the averaged neointimal area divided by the averaged stent area multiplied by 100 (%).


RESULTS
After 6 months of treatment, angiographic in-stent restenosis (17% vs 43%, respectively, P =.0994) and target lesion revascularization (13% vs 38%, respectively, P =.0835) were less frequent in the pioglitazone group than the control group; however, these differences did not reach significance. The intravascular ultrasound scanning study demonstrated that the neointimal index in the pioglitazone group was significantly smaller than that in the control group (28% +/- 9% vs 48% +/- 15%, respectively, P <.0001).


CONCLUSIONS
A serial intravascular ultrasound scanning assessment demonstrated that pioglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with type 2 diabetes mellitus.
Takagi
Tsutomu
T
Takagi Cardiology Clinic, Kyoto, Japan. tcardiol@qb4.so-net.ne.jp
Yamamuro
Atsushi
A
Tamita
Koichi
K
Yamabe
Kenji
K
Katayama
Minako
M
Mizoguchi
Shin
S
Ibuki
Motoaki
M
Tani
Tomoko
T
Tanabe
Kazuaki
K
Nagai
Kunihiko
K
Shiratori
Kenichi
K
Morioka
Shigefumi
S
Yoshikawa
Junichi
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose / Q000378:metabolism; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D000077205:Pioglitazone; D015607:Stents; D013844:Thiazoles / Q000494:pharmacology* / Q000627:therapeutic use; D045162:Thiazolidinediones; D017539:Tunica Intima / Q000187:drug effects* / Q000473:pathology; D018084:Ultrasonography, Interventional
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D008055:Lipids; D013844:Thiazoles; D045162:Thiazolidinediones; D000077205:Pioglitazone