Article Text

other Versions

PDF
Efficacy and Safety of Pioglitazone in Patients With ST-Elevation Myocardial Infarction Treated With Primary Stent Implantation
  1. Hideaki Kaneda (hdkaneda{at}gmail.com)
  1. Shonan Kamakura General Hospital, Japan
    1. Takaaki Shiono
    1. Shonan Kamakura General Hospital, Japan
      1. Yusuke Miyashita
      1. Shonan Kamakura General Hospital, Japan
        1. Saeko Takahashi
        1. Shonan Kamakura General Hospital, Japan
          1. Yoshio Taketani
          1. Shonan Kamakura General Hospital, Japan
            1. Hiroshi Domae
            1. Shonan Kamakura General Hospital, Japan
              1. Junya Matsumi
              1. Shonan Kamakura General Hospital, Japan
                1. Shingo Mizuno
                1. Shonan Kamakura General Hospital, Japan
                  1. Yoshiyasu Minami
                  1. Shonan Kamakura General Hospital, Japan
                    1. Kazuya Sugitatsu
                    1. Shonan Kamakura General Hospital, Japan
                      1. Shigeru Saito
                      1. Shonan Kamakura General Hospital, Japan

                        Abstract

                        Objectives: To examine the safety and efficacy of pioglitazone in patients with ST-elevation myocardial infarction (STEMI) treated with primary bare metal stent (BMS) implantation.

                        Background: While recent studies have shown that thiazolidinediones reduce neointimal hyperplasia after BMS implantation, this drug classification sometimes cause fluid retention that may lead to heart failure.

                        Methods: Diabetic or non-diabetic patients with STEMI (<12 hrs from onset) successfully treated with primary BMS implantation were randomized to either the pioglitazone (15mg, up to 30mg) or control groups. Patients in cardiogenic shock were excluded. Primary efficacy endpoint was percent neointimal volume within the stented segment at 6 months using 3D intravascular ultrasound. Safety endpoint was a composite of all-cause mortality, re-infarction, or heart failure requiring hospitalization.

                        Results: Between October 2005 and July 2007, 96 patients were randomized into the pioglitazone (N=48) or control group (N=48). At follow-up, percent neointimal volume and neointimal volume index were significantly reduced in the pioglitazone group (22±13 vs. 28±13 %, P=0.04; 1.5±0.9 vs. 2.0±0.8 mm3/mm, P=0.02). During 6 months, 2 control patients died, 4 patients (1 in pioglitazone group, 3 in control) suffered from stent thrombosis resulting in re-infarction, and 3 patients (2 in pioglitazone group, 1 in control) had heart failure, resulting in similar incidence of safety endpoint (3 vs. 6).

                        Conclusions: Treatment of pioglitazone reduced neointimal hyperplasia in STEMI patients treated with primary stent implantation without placing the patient at increased risk of complications. Additional larger trials will be necessary to establish the clinical benefit of pioglitazone.

                        Statistics from Altmetric.com

                        Request permissions

                        If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.