Role of Pioglitazone in the Prevention of Restenosis and Need for Revascularization After Bare-Metal Stent Implantation: A Meta-Analysis

Abstract

We performed a meta-analysis to evaluate the impact of pioglitazone in the prevention of in-stent restenosis (ISR) and need for revascularization after bare-metal stent (BMS) implantation. BMS use is associated with a significant incidence of restenosis. Pioglitazone, a thiazolidinedione (TZD), has been shown in small studies to be associated with decreased neointimal formation after BMS implantation. The meta-analysis included randomized controlled trials that randomized patients undergoing BMS implantation into pioglitazone treatment in combination with standard treatment or standard treatment only. All randomized controlled trials followed patients for 6 months with baseline and follow-up angiographies. The ISR and revascularization rate were considered primary outcomes. We identified 6 eligible studies involving 373 patients (187 in the pioglitazone group and 186 in the control group). Use of pioglitazone was associated with decreased late loss, a larger minimal lumen diameter, and a lower percentage diameter stenosis (p < 0.01). The angiographic ISR rate was decreased with pioglitazone (p < 0.01), and patients who received pioglitazone were significantly less likely to undergo revascularization (p < 0.01). Intravascular ultrasound analysis also demonstrated decreased neointima formation in the pioglitazone group. Subgroup analysis showed significant reduction in ISR and need for revascularization for studies involving only diabetic patients, whereas analysis of the remaining studies demonstrated nonsignificant reduction. This meta-analysis suggests that treatment with pioglitazone is effective in decreasing ISR and need for revascularization after BMS implantation in patients with diabetes. A randomized clinical trial evaluating the hypothesis that administration of pioglitazone reduces restenosis in diabetic patients after BMS implantation seems warranted.