Elsevier

Atherosclerosis

Volume 202, Issue 2, February 2009, Pages 521-528
Atherosclerosis

Effect of thiazolidinediones on in-stent restenosis in patients after coronary stenting: A meta-analysis of randomized controlled trials

https://doi.org/10.1016/j.atherosclerosis.2008.05.029Get rights and content

Abstract

Background

Recent experimental studies have demonstrated that thiazolidinediones (TZDs) therapy inhibits proliferation and migration of vascular smooth muscle cells, accelerates endothelium reparation and attenuates neointimal hyperplasia. It implies that TZDs therapy may have beneficial effects on in-stent restenosis (ISR). Several small-sample clinical trials have evaluated the effect of TZDs therapy on ISR, however, the results were inconsistent across trials.

Methods and results

We performed a meta-analysis of all relevant randomized controlled trials to evaluate the effect of TZDs therapy on in-stent restenosis in patients undergoing coronary stenting. Eight trials involving 366 patients were included in this study. TZDs therapy was associated with a significant reduction in the risk of ISR in both diabetic (RR 0.37, 95% CI 0.23–0.59; P < 0.0001) and non-diabetic patients (RR 0.16, 95% CI 0.05–0.45; P = 0.0006). TZDs therapy was associated with a significant reduction in late lumen loss (WMD −0.54 mm, 95% CI −0.87 mm, −0.22 mm; P = 0.001), percent diameter stenosis (WMD −15.7%, 95% CI −19.4%, −12.0%; P < 0.00001), neointimal area/volume (SMD −0.76, 95% CI −1.13, −0.39; P < 0.0001) and target lesion revascularization (RR 0.32, 95% CI 0.18–0.57; P = 0.0001).

Conclusions

Our study suggests that TZDs therapy is an effective strategy in preventing ISR in both diabetic and non-diabetic patients undergoing coronary stenting. More studies, especially large multi-centre RCTs, are still warranted to further clarify the anti-restenotic effect of TZDs therapy.

Section snippets

Search strategy

Electronic databases including PubMed (1966–May 2007), EMBase (1980–May 2007), BIOSIS Previews (1997–week 16, 2007), and Cochrane central register of controlled trials (2nd Quarter 2007) were searched by using the Mesh and text keywords thiazolidinediones, pioglitazone, rosiglitazone, percutaneous coronary intervention, stent and restenosis. References from these trials were scrutinized to reveal additional citations. Conference proceedings from American College of Cardiology (2003–2006),

Study selection

Eight RCTs (6 RCTs in full-text publications [11], [12], [13], [14], [15], [16] and 2 RCTs in conference abstracts [17], [18]) with 366 intention-to-treat (ITT) participants were identified for inclusion from 420 potentially relevant publications. Among these trials, 5 trials [11], [12], [13], [14], [18] included 261 diabetic patients and 3 trials [15], [16], [17] recruited 105 non-diabetic (metabolic syndrome, normal or impaired glucose tolerance) patients.

Baseline characteristics and study quality

Table 1 summarizes the baseline

Discussion

This meta-analysis illustrates that TZDs therapy for 6 months after coronary stenting significantly reduces the risk of ISR, diameter stenosis, late lumen loss, and neointimal area/volume in both diabetic and non-diabetic patients.

The effect of TZDs therapy on the risk of TLR is inconsistent when including or excluding the conference abstracts. The reasons were as followings. First, the sample size, especially in non-diabetic population, was relatively small, so the outcome was greatly affected

Conclusions

In conclusion, our study suggests that TZDs therapy is an effective strategy in preventing ISR in both diabetic and non-diabetic patients with coronary stent implantation. More studies, especially large multi-centre RCTs, are still warranted to further clarify the anti-restenotic effect of TZDs therapy.

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    1

    Department of Cardiology, The Second Affiliated Hospital, Sun Yat-sen University, No. 107 West Yanjiang Road, Guangzhou 510120, China.

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