Pcv26 Effects of Thiazolidinediones on Cardiovascular Events in Patients With Type-2 Diabetes Mellitus After Drug-Eluting Stent Implantation

Abstract

OBJECTIVES:To compare clinical outcomes of type 2 diabetic patients with and without TZDs therapy after patients receiving DES. METHODS: We conducted a retrospective cohort study using the National Health Insurance Database (NHIRD). The type 2 diabetes mellitus patients were included if they received first limuseluting stent or paclitaxel-eluting stent placement and were identified by presence of a hospital claim during the period from December 1, 2006, through December 31, 2007. Follow-up data were available through December 31, 2008. Patients were classified into two groups based on the antidiabetic agents they took from pharmacy records for use of TZD (rosiglitazone, pioglitazone) or non-TZD within 3 months after the index date of hospitalization. A total of 1,743 patients who received stents during the study period were identified as the study subjects. Our measure of effectiveness was the prevalence of death, myocardial infarction and repeat revascularization, defined as any PCI, whether or not the patient received a stent, or crossed over to CABG within one year after index hospitalization. RESULTS: There were 268 patients in TZD group, 1,475 patients in non-TZD group. Compared with non-TZD group, there were no significant difference in adjusted hazard ratio of death, myocardial infarction and repeat revascularization between limus-eluting stent group and paclitaxel-eluting stent group. In stratified analysis, patients who received limus-eluting stent with history of myocardial infarction and treated with TZDs were associated with a higher risk of myocardial infarction (HRϭ 5.292,. CONCLUSIONS: Our findings suggest that TZDs could not improve clinical outcomes in type 2 diabetes patients after drug-eluting stent implantation. TZDs may contribute to higher risk of myocardial infarction in patient with limus-eluting stent and history of myocardial infarction. For the pleiotropic effects of TZDs, balance between benefit and risk for cardiovascular events to different subgroups, may be different.Further studies are required to investigate this relationship.