HYPOTHESES * Rosiglitazone in diabetic patients with previous coronary bypass surgery may prevent or slow the progression of atherosclerosis in SVGs and native coronary arteries. * Rosiglitazone has favorable effects on adipose tissue distribution variables as well as on thrombosis, pro-inflammatory, and lipid profiles in diabetic patients after coronary bypass artery surgery. * Rosiglitazone therapy influences favorably metabolism and clinical outcomes in diabetic patients after coronary artery bypass surgery. OBJECTIVES * PRIMARY To assess the efficacy of rosiglitazone to reduce atherosclerosis progression in vein grafts in diabetic patients after coronary bypass surgery by using IVUS imaging after a 12 mo follow-up. * SECONDARY * To prospectively compare the secondary IVUS endpoints. * To prospectively compare the angiographic endpoints. * To prospectively compare the metabolic risk factor endpoints. * To prospectively compare the body composition and distribution endpoints. * To prospectively compare the clinical outcomes of rosiglitazone versus standard care using composite endpoints.
STUDY DESIGN This is a prospective multicenter randomized placebo-controlled double-blind trial assessing the efficacy and safety of rosiglitazone in the prevention of atherosclerosis progression in vein grafts and native coronary arteries of diabetic patients. Stable diabetic patients with previous coronary bypass surgery (≥ 1 year ≤ 10 years) will be screened. After baseline evaluation, all eligible patients will undergo baseline coronary angiogram. IVUS will be performed in a segment length of at least 40 mm in a SVG suitable for IVUS analysis and in a segment length of at least 20 mm in the anastomosed native coronary artery corresponding to the SVG chosen. Following the IVUS procedure, patients will be randomized to either rosiglitazone treatment or to placebo in addition to their standard clinical care. Study drug will be titrated over an 8-week period up to a dose of 8 mg/day (or to maximum tolerated dose). The patients will receive the study drug or the placebo for 50-54 weeks in a double-blind manner. At the beginning and at 2, 4, 6, 8, 10 and 12 months of treatment, patients will be subjected to a set of morphological, physiological and metabolic evaluations. At the final visit (12 months), patients will also be submitted to IVUS and angiography.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
193
Rosiglitazone 4 to 8 mg/day or placebo, for 12 months
QEII Health Sciences Center - Halifax Infirmary
Halifax, Nova Scotia, Canada
Hamilton Health Sciences - Mc Master Clinic
Hamilton, Ontario, Canada
Toronto General Hospital
Toronto, Ontario, Canada
CRMSBC
Bonaventure, Quebec, Canada
CHUM Notre-Dame Hospital
Montreal, Quebec, Canada
Laval Hospital
Sainte-Foy, Quebec, Canada
Hospital Del Mar
Barcelona, Spain
Hospital Universitari Vall D'Hebron
Barcelona, Spain
Hospital Universitarion Son Dureta
Palma de Mallorca, Spain
Change in plaque volume in one SVG (by IVUS)
Time frame: 12 months
1 Change in plaque volume in segment of anastomosed coronary artery
Time frame: 12 months
2 Changes in lumen and total vessel volumes and lumen plaque total vessel areas in SVG and coronary segments
Time frame: 12 months
3 Changes in qualitative plaque characterization in the SVG and coronary segments
Time frame: 12 months
4 Patients showing atherosclerosis changes
Time frame: 12 months
5 Atherosclerosis changes concordance and discordance
Time frame: 12 months
6 New occlusions in native coronary arteries or SVGs
Time frame: 12 months
7 Changes in reference and minimum lumen diameters of the SVG
Time frame: 12 months
8 Per patient percentage of initially patent SVGs that had significant progression of atherosclerosis at the site of greatest change at follow-up
Time frame: 12 months
9 Changes of indices for comprehensive lipid thrombosis and pro-inflammatory profiles as well as glucose-insulin homeostasis, microalbuminuria, adhesion molecules, adipokines, and other markers relevant to the evaluation and management of cardiovascular
Time frame: 12 months
10 Changes in abdominal areas and volumes of adipose tissue areas
Time frame: 12 months
11 Changes in body composition, body weight, waist circumference and BMI
Time frame: 12 months
12 Clinical laboratory parameters, physical examinations, vital signs, ECGs, concomitant medication and adverse events
Time frame: 12 months
13 Death, MI, TIA, stroke, hospitalization and ischemia-driven interventions
Time frame: 12 months
14 Fluid retention
Time frame: 12 months
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