Comparison of bare metal stent with pioglitazone versus sirolimus-eluting stent for percutaneous coronary intervention in patients with Type 2 diabetes mellitus.
BACKGROUND
Drug-eluting stents (DESs) have been shown to decrease restenosis as compared with bare-metal stents. Recently, thiazolidinediones effectively reduced restenosis and the risk of repeat target vessel revascularization. We conducted a study to compare the performance of a DES with that of a bare-metal stent with pioglitazone in patients with Type 2 diabetes mellitus (DM).


METHODS
The study was a prospective cohort trial involving 38 Type 2 diabetic patients referred for coronary stenting who were assigned to either the sirolimus-eluting stent (SES) group or the pioglitazone group. Quantitative coronary angiography was performed at study entry and at 6 months of follow-up to evaluate in-stent late luminal loss and the percentage of the luminal diameter and the rate of restenosis. We also analyzed major adverse cardiac events (MACE) at 12 months.


RESULTS
There were no significant differences in glycemic control levels or in lipid levels in the two groups at follow up. The insulin and homeostasis model assessment insulin resistance at follow-up were significantly lower in the pioglitazone group than in the SES group. The percentage of restenosis was similar between the SES group and the pioglitazone group. The incidence of MACE at 1 year tended to be lower in the pioglitazone group than in the SES group.


CONCLUSIONS
The bare-metal stent with pioglitazone is not inferior to the SES in the present study and is one of therapeutic strategies of percutaneous coronary intervention for patients with DM.
Nishio
Kazuaki
K
The Third Department of Internal Medicine, School of Medicine, Showa University, Tokyo, Japan. kazukun@jg7.so-net.ne.jp
Shigemitsu
Meiei
M
Kodama
Yusuke
Y
Konno
Noburu
N
Katagiri
Takashi
T
Kobayashi
Youichi
Y
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D001786:Blood Glucose / Q000187:drug effects; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology / Q000517:prevention & control; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008297:Male; D008670:Metals; D008875:Middle Aged; D000077205:Pioglitazone; D011446:Prospective Studies; D011474:Prosthesis Design; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D045162:Thiazolidinediones / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D001786:Blood Glucose; D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids; D008670:Metals; D045162:Thiazolidinediones; D020123:Sirolimus; D000077205:Pioglitazone