Cardiovascular preventive role of thiazolidinedione in patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention

BACKGROUND: Thiazolidinediones (TZD) are a class of oral antidiabetic medications that improve glycemic control and insulin sensitivity. We evaluated the cardiovascular outcomes according to thiazolidinedione (TZD) use in patients with type 2 diabetes mellitus (T2DM) undergoing percutaneous coronary intervention (PCI). METHODS: Using the national health claims database in South Korea, we constructed a cohort of type 2 diabetes mellitus patients who underwent PCI between 2015 and 2022. Patients were classified as TZD users or nonusers and matched at a 1:3 ratio using propensity score matching. Stratified Cox regression analysis was performed to evaluate the risk for the primary composite outcome, which included myocardial infarction (MI), stroke, and all-cause death. RESULTS: Among 169,747 patients with type 2 diabetes mellitus who underwent PCI, 7.4% were TZD users. During a mean follow-up of 3.63 ± 2.30 years, 31,813 patients (18.7%) experienced the primary outcome. In the stratified Cox regression analysis, which consisted of 12,597 TZD users and 37,791 nonusers, TZD treatment was associated with a lower risk of primary outcome (HR 0.87, 95% CI: 0.83-0.92, P < 0.001). No difference was observed in the risk of heart failure admission between TZD nonusers and users. CONCLUSIONS: TZD treatment in type 2 diabetes mellitus patients undergoing PCI was associated with a reduced risk of adverse cardiovascular events.