Abstract
BackgroundIn-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.MethodsRandomized 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.ResultsFive 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).ConclusionsThe 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.
Highlights
In-stent restenosis (ISR), stenosis more than 50% at the site of stent [1], has been considered as the leading problem after percutaneous coronary intervention (PCI)
A meta-analysis showed that drug-eluting stent (DES) compared with bare-metal stent (BMS) markedly reduced the incidence of ISR [2]
Studies included in the meta-analysis satisfied the following criteria: (i) randomized controlled trials were limited to human subjects; (ii) patients were individuals undergoing drug-eluting stents (DES) implantation, with or without diabetes mellitus; (iii) studies compared pioglitazone with placebo for restenosis after DES implantation; (iv) in addition to study medications, all patients received recommended post-PCI medical interventions such as aspirin, statins, beta blockers, angiotensin-converting enzyme inhibitor; (v) sufficient information was supplied for both baseline and follow-up angiography and/or intravascular ultrasound (IVUS) data; (vi) subjects were followed for at least 6 months
Summary
In-stent restenosis (ISR), stenosis more than 50% at the site of stent [1], has been considered as the leading problem after percutaneous coronary intervention (PCI). Thiazolidinediones (TZDs), which are widely used as insulin-sensitizers in the treatment of diabetes mellitus [7,8], can inhibit proliferation and migration of vascular smooth muscle cells (VSMCs) and reduce intimal proliferation after vascular injury [9,10,11,12,13]. These evidences provide the rationale for assessing effect of TZDs on limiting ISR. We conducted a metaanalysis to assess the effect of pioglitazone in preventing ISR after DES implantation
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