Effect of thiazolidinedione therapy on restenosis after coronary stent implantation: a meta-analysis of randomized controlled trials.
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.
Rosmarakis
Evangelos S
ES
Alfa Institute of Biomedical Sciences, Athens, Greece.
Falagas
Matthew E
ME
D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D016017:Odds Ratio; D015607:Stents / Q000009:adverse effects*; D045162:Thiazolidinediones / Q000627:therapeutic use*
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; C089946:2,4-thiazolidinedione