New TAXUS stent more effective for angioplasties

A new finding from the TAXUS IV trial shows that a novel stent can reduce rates of restenosis in patients with coronary artery disease who are undergoing angioplasty. The new stent releases a chemical (paclitaxel) which leads to significantly lower rates of re-occlusion compared with a bare metal stent.

Patients that present with chest pain due to a heart attack or severe (unstable) angina often have an angioplasty performed (PTCA) to bypass a fixed blockage in one or more of their coronary arteries. To re-open the occluded vessel, a balloon is used to distend it, and then a stent is often inserted to keep it open and prevent re-occlusion. The vessel often re-occludes with time, however, despite the presence of the stent.The trial, published in the New England Journal of Medicine, involved, 1314 patients who had a stent inserted for a single, previously untreated stenosis (of length 10-28 mm) in one of the coronary arteries.Participants were randomly assigned to either receive a bare metal stent (n=652), or a slow-release, paclitaxel-eluting polymer stent called TAXUS. Stone et al report that target vessel revascularization (TVR) at 9 months was more than twice as common with the TAXUS stent (12.0%) than the bare metal stent (4.7%, relative risk [RR]=0.39, p<0.001). In addition, restenosis (judged by angiography was also significantly higher with bare metal stents the drug-eluting stent, at 26.6% versus 7.9% (RR=3.0, p<0.001). However, despite having lower re-occlusion rates, the TAXUS stent did not lead to a survival advantage, with the 9 month survival rate being the same for both groups of patients.The team concluded that the new TAXUS stent is effective in reducing the rates of re-occlusion and having higher revascularisation rates, however, longer follow-up is needed to establish its safety and look for other similar devices. New Engl J Med 2003; 350: 221-231