title: Effect of pioglitazone on in-stent restenosis after coronary drug-eluting stent implantation: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  In-stent restenosis (ISR) remains a common life-threatening complication and some studies have shown that pioglitazone can reduce the incidence of ISR in patients with drug-eluting stents (DES) implantation. We conducted a meta-analysis to assess the effect of pioglitazone in preventing ISR after DES implantation.
  
  
  METHODS
  Randomized controlled trials (RCTs) investigating the effects of pioglitazone for ISR after DES implantation were identified by systematic searches of multiple online databases and manual searches of related reference lists of identified trials through May 2014. The primary endpoint was the rate of ISR. Secondary endpoints included minimum lumen diameter, percentage stenosis of stented vessels, late loss, in-stent neointimal volume, target vessel revascularization (TVR), target lesion revascularization, myocardial infarction, stent thrombosis and death.
  
  
  RESULTS
  Five studies, comprising 255 pioglitazone-treated patients and 245 controls, were identified in the current meta-analysis. Pioglitazone did not significantly reduce the rate of ISR (P = 0.20) with low heterogeneity (I2 = 13.3%, P = 0.32). For the secondary outcomes, pioglitazone did not substantially affect the pooled estimates of these endpoints except late loss (P = 0.01) and TVR (P = 0.04).
  
  
  CONCLUSIONS
  The limited evidence indicates that pioglitazone does not demonstrate markedly beneficial effect in patients subjected to coronary DES implantation. However, the results should be interpreted with care given the small sample size. Further large-scale RCTs are needed.
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
authors.forename: Ming-duo
authors.initials: MD
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
authors.forename: Yu-hui
authors.initials: YH
authors.lastname: Zhang
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: En-jun
authors.initials: EJ
authors.lastname: Zhu
authors.affiliation: Department of Cardiology, Rizhao People's Hospital, Shandong, China.
authors.forename: Shi-bin
authors.initials: SB
authors.lastname: Qiao
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
authors.forename: Shu-zheng
authors.initials: SZ
authors.lastname: Lv
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
authors.forename: Quan-ming
authors.initials: QM
authors.lastname: Zhao
mesh_terms: D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000209:etiology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000077205:Pioglitazone; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D045162:Thiazolidinediones / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077205:Pioglitazone