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

Study Questions:

What is the impact of pioglitazone in the prevention of in-stent restenosis (ISR) and need for revascularization after bare-metal stent (BMS) implantation?

Methods:

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 rates were considered primary outcomes. Odds ratios and 95% confidence intervals were calculated to demonstrate the overall result of the dichotomous data, including ISR and need for revascularization.

Results:

The investigators identified six 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.

Conclusions:

The authors concluded that treatment with pioglitazone is effective in decreasing ISR and need for revascularization after BMS implantation in patients with diabetes.

Perspective:

The results of this meta-analysis indicate a significant clinical benefit in diabetic patients with the addition of pioglitazone to standard medical therapy in reducing the incidence of ISR in BMS at 6 months. Subgroup analysis demonstrated that studies involving only diabetic patients (with glycated hemoglobin >6.5) showed more benefit from using pioglitazone than the remaining studies (with glycated hemoglobin <6.5). Given the small number of trials included in the meta-analysis, relatively short follow-up, and no difference in the incidence of myocardial infarction, congestive heart failure, or death at 6 months, larger randomized studies are indicated to confirm these findings.

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Acute Heart Failure

Keywords: Neointima, Paclitaxel, Myocardial Infarction, Follow-Up Studies, Thrombosis, Drug-Eluting Stents, Heart Failure, Sirolimus, Thiazolidinediones, Diabetes Mellitus, Stents


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