Different Effects of Thiazolidinediones on In-Stent Restenosis and Target Lesion Revascularization after PCI: A Meta-Analysis of Randomized Controlled Trials

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.

Targeting smooth muscle cell phenotypic switching in vascular disease

“… 130 , 132 TZDs exert antiproliferative, antiplatelet, and anti-inflammatory effects and promote VSMC differentiation ( Fig 5 ). PPAR-γ agonists decrease intimal hyperplasia after PCI, 133 , 134 and vascular PPAR-γ expression was strongly repressed after arterial stenting in minipigs. Systemic rosiglitazone treatment rescued both PPAR-γ and contractile protein expression after stenting and decreased inflammation.…”

Addition of Radix Salviae Decoction for a Short Period Does Not Significantly Change Coronary Stenosis and Restenosis After Percutaneous Coronary Intervention: A Prospective Clinical Trial

“…Some pioneering studies on the preventive medication to ISR showed that thiazolidinedione (TZD) treatment for 6 to 18 months significantly reduced the incidence of ISR, target lesion revascularization, and major adverse cardiovascular events in patients after PCI, and Pioglitazone treatment seems to have more beneficial effects than Rosiglitazone. 36 Nevertheless, few studies have shown the efficacy and safety of herbal medicines in preventing ISR incidence. Our data in another study found that RSD combined with remote ischemic preconditioning did not significantly affect angina attack and prognosis of CHD, but decreased the frequency of emergency medications in CHD patients, indicating a therapeutic effect of RSD in CHD.…”

Statins and the Risk for Coronary in-Stent Restenosis in Diabetic Patients

“…In our study compliance with double antiplatelet therapy was good, with no statistically significant differences between patients with or without stent angiographic restenosis. Information on the possible protective effect of anti-diabetic medication on stent restenosis is inconsistent and inconclusive [11,[29][30][31][32]. Several studies have suggested that some oral antidiabetics, such as thiazolidinediones, lower the risk of stent restenosis and major post-procedural cardiac events [11,29].…”

“…Information on the possible protective effect of anti-diabetic medication on stent restenosis is inconsistent and inconclusive [11,[29][30][31][32]. Several studies have suggested that some oral antidiabetics, such as thiazolidinediones, lower the risk of stent restenosis and major post-procedural cardiac events [11,29]. On the other hand, although preclinical studies have indicated that insulin administration reduces intimal hyperplasia, the incidence of in-stent restenosis does not appear to be influenced when comparing insulin therapy with usual care with oral hypoglycaemic agents [30].…”