Abstract
In-stent restenosis (ISR) remains the leading problem encountered after percutaneous coronary intervention (PCI). Thiazolidinediones (TZDs) has been shown to be associated with reduced ISR and target lesion revascularization (TLR); however, the results are inconsistent, especially between rosiglitazone and pioglitazone. In this study, fourteen RCTs with a total of 1350 patients were finally included through a systematical literature search of Embase, Pubmed, the Cochrane Library, and ClinicalTrials.gov from inception to January 31, 2017. The follow-up duration of the included trials ranged from 6 months to 18 months. The results demonstrated that TZDs treatment is associated with significantly reduced risk of TLR (RR:0.45, 95%CI 0.30 to 0.67 for pioglitazone, RR:0.68, 95%CI 0.46 to 1.00 for rosiglitazone). Pioglitazone is associated with significantly reduced risks of ISR (RR:0.47, 95%CI 0.27 to 0.81), major adverse cardiac events (MACE) (RR:0.44, 95%CI 0.30 to 0.64) and neointimal area (SMD: −0.585, 95%CI −0.910 to −0.261). No significant relationship was observed between rosiglitazone and ISR (RR:0.91, 95%CI 0.39 to 2.12), MACE (RR:0.73, 95%CI 0.53 to 1.00) and neointimal area (SMD: −0.164, 95%CI −1.146 to 0.818). This meta-analysis demonstrated that TZDs treatment is associated with significant reduction in ISR, TLR and MACE for patients after PCI. Pioglitazone treatment seems to have more beneficial effects than rosiglitazone and no significantly increased cardiovascular risk was detected for both agents.
Highlights
Studies were required to meet the following criteria to be included in the research: (1) randomized controlled trial (RCT), (2) original data showing the effects of TZDs after percutaneous coronary intervention (PCI), (3) TZDs therapy compared with placebo, without TZDs, or other anti-diabetic therapy, (4) the outcomes of interest were reported, and (5) the length of follow-up was at least 6 months
14 RCTs with a total of 1350 patients were included in the analysis, with follow-up ranging from 6 months to 18 months after intervention[16,17,18,19,20,21,22,23,24,25,26,27,28,29]
8 trials were treated with pioglitazone[20,21,22,23,24,25,27,28], and 6 trials were treated with rosiglitazone[16,17,18,19,26,29]
Summary
The results demonstrated that TZDs treatment is associated with significantly reduced risk of TLR (RR:0.45, 95%CI 0.30 to 0.67 for pioglitazone, RR:0.68, 95%CI 0.46 to 1.00 for rosiglitazone). No significant relationship was observed between rosiglitazone and ISR (RR:0.91, 95%CI 0.39 to 2.12), MACE (RR:0.73, 95%CI 0.53 to 1.00) and neointimal area (SMD: −0.164, 95%CI −1.146 to 0.818) This meta-analysis demonstrated that TZDs treatment is associated with significant reduction in ISR, TLR and MACE for patients after PCI. Previous meta-analysis have demonstrated benefits of both TZDs and pioglitazone in prevention of ISR and target lesion revascularization (TLR)[8,9,10,11,12] Few of these analyses are based on RCT data; the results of these studies are inconsistent
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