Angiographic and Clinical Outcomes of Rosiglitazone in Patients With Type 2 Diabetes Mellitus After Percutaneous Coronary Interventions: A Single Center Experience

Abstract

A beneficial effect of thiazolidinediones includes the reduction of intermediate markers, suggesting a potential for reducing atherosclerosis and restenosis. The objective of this study was to determine if rosiglitazone (RSG) reduced the odds of restenosis and if RSG improved the odds of clinical outcomes after percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) patients. A total of 609 patients with 734 lesions were selected from the period between January 1, 2001 and January 31, 2004. These patients were divided into 2 groups: a "control" group representing patients seen between January 1, 2001 and September 2002 when RSG was not available in our hospital and a "RSG treatment" group representing patients seen between September 2002 and January 31, 2004 when RSG was available in our hospital. Thus, 213 patients with 253 lesions (1.19 L/P) were placed in the RSG group and 396 patients with 481 lesions (1.21 L/P) were placed in the control group. Subgroup analysis based on the PCI received had 88 patients in the RSG arm receiving balloon angioplasty and 125 patients receiving coronary stenting; the control group had 187 and 209 patients, respectively, in the subgroups. Primary endpoint was angiographic restenosis at 6 months, and secondary endpoints were death, myocardial infarction, and target lesion revascularization. More patients in the control group were insulin-requiring, had poorer left ventricular function, but had a larger preprocedural minimal lumen diameter (pre-MLD). At 6 months, restenosis and reocclusion rates were lower in the RSG group (P = .014 and P = .006, respectively). Twenty-nine patients died in the control group versus 1 in the RSG group (P <or= .001). RSG (P = .019), stenting (P = .005), preprocedural reference vessel diameter (P = .017), metformin (P = .022), pre-MLD (P < .001), hyperlipidemia (P = .016), and combined RSG and metformin (P = .020) were predictors of restenosis, while RSG (P = .016) and metformin (P = .029) were predictors of survival. In conclusion, RSG was found safe and well tolerated and was associated with reduced odds of restenosis, reocclusion, and mortality rates in type 2 DM patients independent of glycemic control and PCI performed.

The role of glucose lowering agents on restenosis after percutaneous coronary intervention in patients with diabetes mellitus

“…that in 38 type 2 diabetics similar restenosis rates were present in patients treated with either a BMS with pioglitazone or sirolimus-eluting stent without pioglitazone [49]. Fang et al (2007) demonstrated that rosiglitazone therapy in comparison to standard antidiabetic therapy without rosiglitazone in type 2 diabetics leads to a significant decrease in restenosis and mortality [50]. However, the intervention group significantly used more insulin and biguanides, which might lead to bias of the observed effects.…”

Rosiglitazone and Outcomes for Patients With Diabetes Mellitus and Coronary Artery Disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

“…In early studies thiazolidinediones including rosiglitazone demonstrated effects associated with cardiovascular benefit, including improvement of endothelial dysfunction, 2-4 reduction of inflammatory markers, 5, 6 and inhibition of atherosclerosis progression. 7, 8 …”

Different Effects of Thiazolidinediones on Cardiovascular Risk in Patients with Type 2 Diabetes Mellitus: Pioglitazone vs Rosiglitazone

“…However, results from a meta-analysis of 5 RCTs with at least 6 months of TZD therapy (N=235) revealed that among the PIO and ROSI-treated patients, restenosis rates were significantly lower (OR 0.29, 95% CI 0.15-0.56), percentage diameter stenosis was significantly reduced (weighted difference in means 14.35, 95% CI 8.72-19.99, random effects model), and those patients were less likely to undergo target lesion revascularization due to restenosis (OR 0.24, 95% CI 0.09-0.61) [59]. Consistent with these results are those from a retrospective single-center observational study that included patients with T2D, coronary disease, and PCI (N=609) [60]. Angiographic evaluation 6 months after PCI showed that restenosis and reocclusion rates were lower in the ROSI group vs the control group (restenosis 46% vs 55%, p=0.014; reocclusion 2% vs 6%, p=0.006).…”