Effect of thiazolidinediones on in-stent restenosis in patients after coronary stenting: a meta-analysis of randomized controlled trials

Atherosclerosis. 2009 Feb;202(2):521-8. doi: 10.1016/j.atherosclerosis.2008.05.029. Epub 2008 May 28.


Background: Recent experimental studies have demonstrated that thiazolidinediones (TZDs) therapy inhibits proliferation and migration of vascular smooth muscle cells, accelerates endothelium reparation and attenuates neointimal hyperplasia. It implies that TZDs therapy may have beneficial effects on in-stent restenosis (ISR). Several small-sample clinical trials have evaluated the effect of TZDs therapy on ISR, however, the results were inconsistent across trials.

Methods and results: We performed a meta-analysis of all relevant randomized controlled trials to evaluate the effect of TZDs therapy on in-stent restenosis in patients undergoing coronary stenting. Eight trials involving 366 patients were included in this study. TZDs therapy was associated with a significant reduction in the risk of ISR in both diabetic (RR 0.37, 95% CI 0.23-0.59; P<0.0001) and non-diabetic patients (RR 0.16, 95% CI 0.05-0.45; P=0.0006). TZDs therapy was associated with a significant reduction in late lumen loss (WMD -0.54 mm, 95% CI -0.87 mm, -0.22 mm; P=0.001), percent diameter stenosis (WMD -15.7%, 95% CI -19.4%, -12.0%; P<0.00001), neointimal area/volume (SMD -0.76, 95% CI -1.13, -0.39; P<0.0001) and target lesion revascularization (RR 0.32, 95% CI 0.18-0.57; P=0.0001).

Conclusions: Our study suggests that TZDs therapy is an effective strategy in preventing ISR in both diabetic and non-diabetic patients undergoing coronary stenting. More studies, especially large multi-centre RCTs, are still warranted to further clarify the anti-restenotic effect of TZDs therapy.

Publication types

  • Meta-Analysis

MeSH terms

  • Angioplasty, Balloon, Coronary
  • Coronary Artery Disease / therapy*
  • Coronary Restenosis / drug therapy*
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Stents*
  • Thiazolidinediones / therapeutic use*


  • Hypoglycemic Agents
  • Thiazolidinediones
  • 2,4-thiazolidinedione