Thiazolidinediones and risk of repeat target vessel revascularization following percutaneous coronary intervention: a meta-analysis.
OBJECTIVE
Thiazolidinediones (TZDs) (rosiglitazone and pioglitazone) are a class of antidiabetes agents that have a high affinity for peroxisome proliferator-activated receptor-gamma. TZDs initiate a multitude of physiologic processes that may elicit benefits as systemic agents for the prevention of restenosis requiring revascularization following percutaneous coronary intervention (PCI). Numerous trials have evaluated the impact of TZDs on repeat target vessel revascularization (TVR) in patients following PCI; however, several limitations (small sample size, inconclusive results, and risk factor stratification) complicate definitive conclusions. A meta-analysis was performed to evaluate the impact of TZDs on repeat TVR following PCI.


METHODS
Included trials met the following criteria: 1) prospective, randomized controlled trials evaluating available TZDs versus standards of care; 2) well-described protocol; 3) minimum of 6 months of follow-up; and 4) data provided on repeat TVR. Data are presented as relative risks (RRs) with 95% CIs.


RESULTS
Seven clinical trials (n = 608) met the inclusion criteria. Upon meta-analysis, the risk of repeat TVR was significantly reduced in patients who received TZD therapy compared with standards of care (RR 0.35 [95% CI 0.22-0.57]). In studies using rosiglitazone (0.45 [0.25-0.83]) and pioglitazone (0.24 [0.11-0.51]), risk of repeat TVR was significantly reduced. Risk of repeat TVR was also significantly reduced among patients with (0.34 [0.19-0.63]) and without (0.37 [0.18-0.77]) diabetes.


CONCLUSIONS
Results from this meta-analysis suggest that TZDs effectively reduce the risk of repeat TVR following PCI.
Riche
Daniel M
DM
University of Mississippi School of Pharmacy, Department of Pharmacy Practice, University of Mississippi Medical Center, Office Annex Building, WW 116, 2500 North State Street, Jackson, MS 39216, USA.
Valderrama
Rodrigo
R
Henyan
Nickole N
NN
D002986:Clinical Trials as Topic; D006801:Humans; D009204:Myocardial Revascularization / Q000009:adverse effects*; D012008:Recurrence; D045162:Thiazolidinediones / Q000009:adverse effects*
D045162:Thiazolidinediones