FOCUS ISSUE: DRUG-ELUTING STENTS: TAXUS-IV
Outcomes of paclitaxel-eluting stent implantation in patients with stenosis of the left anterior descending coronary artery
George Dangas, MD, PhD, FACC*,
Stephen G. Ellis, MD, FACC ,1,
Richard Shlofmitz, MD, FACC ,
Stanley Katz, MD, FACC ,
David Fish, MD, FACC||,
Steven Martin, MD, FACC¶,
Roxana Mehran, MD, FACC*,
Mary E. Russell, MD#,2,
Gregg W. Stone, MD, FACC*,1,* TAXUS-IV Investigators
* Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
Cleveland Clinic Foundation, Cleveland, Ohio
St. Francis Hospital, Roslyn, New York
North Shore University Hospital, Manhasset, New York
|| St. Luke’s Episcopal Hospital, Houston, Texas
¶ Nebraska Heart Institute, Lincoln, Nebraska
# Boston Scientific Corp., Natick, Massachusetts.
Manuscript received June 28, 2004;
revised manuscript received October 22, 2004,
accepted October 25, 2004.
* Reprint requests and correspondence: Dr. Gregg W. Stone, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022. (Email: gstone{at}crf.org).
OBJECTIVES: We sought to examine the efficacy of paclitaxel-eluting stent implantation in the left anterior descending coronary artery (LAD).
BACKGROUND: Restenosis and recurrent cardiac events after percutaneous intervention are more common for lesions in the LAD than other native coronary arteries, and often necessitate bypass surgery. Drug-eluting stents may improve the long-term prognosis of this high-risk group.
METHODS: In the TAXUS-IV trial, 1,314 patients with single de novo coronary lesions were assigned to implantation of the slow-release, polymer-based, paclitaxel-eluting TAXUS stent or an identical bare-metal stent; 536 (41%) randomized patients had LAD lesions.
RESULTS: Baseline characteristics of patients with LAD lesions were well-matched between the randomized groups. Late lumen loss at nine months after paclitaxel-eluting and control stent implantation were 0.28 ± 0.51 mm and 0.54 ± 0.57 mm, respectively (p = 0.0004), and binary restenosis rates were 11.3% and 26.9%, respectively (p = 0.004). At one year, major adverse cardiac events (MACE) occurred in 13.5% of TAXUS-treated patients versus 21.2% treated with the control stent (p = 0.01). The need for bypass surgery at one year was reduced among patients randomized to the TAXUS stent (2.6% vs. 6.3%, p = 0.02). In the proximal LAD subgroup (n = 126), the one-year target vessel revascularization rate was 7.9% with the TAXUS stent and 18.6% with the bare-metal stent (p = 0.009).
CONCLUSIONS: Compared to bare-metal stents, implantation of polymer-based, paclitaxel-eluting stents in LAD lesions is safe, and reduces angiographic restenosis and MACE one year. Notably, the need for bypass graft surgery due to restenosis is reduced after TAXUS stent implantation in LAD lesions.
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Abbreviations and Acronyms
| | CI = confidence interval | | HR = hazard ratio | | LAD = left anterior descending coronary artery | | LCX = left circumflex coronary artery | | MACE = major adverse cardiac event | | OR = odds ratio | | PCI = percutaneous coronary intervention | | RCA = right coronary artery | | TLR = target lesion revascularization | | TVR = target vessel revascularization |
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