Outcomes with the paclitaxel-eluting stent in patients with acute coronary syndromes: Analysis from the TAXUS-IV trial

Jeffrey W. Moses, Roxana Mehran, Eugenia Nikolsky, John M. Lasala, Woodrow Corey, Glenn Albin, Cary Hirsch, Martin B. Leon, Mary E. Russell, Stephen G. Ellis, Gregg W. Stone

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Abstract

Objectives: We sought to investigate the outcomes of paclitaxel-eluting stent implantation in patients with unstable angina or non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). Background: Whether the paclitaxel-eluting stent is safe and effective in patients with acute coronary syndromes (ACS) is unknown. Methods: In the TAXUS-IV trial, 1,314 patients with stable or unstable ischemic syndromes undergoing PCI were randomized to treatment with either the slow-release, polymer-based, paclitaxel-eluting TAXUS stent or a bare-metal EXPRESS stent (Boston Scientific Corp., Natick, Massachusetts). The results were stratified by the acuity of the presenting clinical syndrome. Results: Acute coronary syndromes were present in 450 patients (34.2%), 237 of whom were assigned to paclitaxel-eluting stents and 213 to bare-metal stents. The baseline and procedural characteristics were well matched between the groups. Clinical outcomes at 30 days were similar with both stents. At one-year follow-up, patients with ACS assigned to the paclitaxel-eluting stent compared to the control stent had strikingly lower rates of target lesion revascularization (TLR) (3.9% vs. 16.0%, p < 0.0001) and major adverse cardiac events (11.1 vs. 21.7%, p = 0.002). By multivariate analysis, ACS was an independent predictor of in-stent restenosis in the cohort treated with bare-metal stents (hazard ratio [HR] = 2.03 [95% confidence interval (CI) 1.05 to 3.92], p = 0.035), while among patients randomized to the paclitaxel-eluting stents, ACS was an independent predictor of freedom from restenosis (HR = 0.27 [95% CI 0.08 to 0.97], p = 0.04). Conclusions: The use of the paclitaxel-eluting TAXUS stent was safe in patients with unstable ischemic syndromes, and was associated with marked reduction of ischemia-driven TLR and adverse cardiac events at one year.

Original languageEnglish
Pages (from-to)1165-1171
Number of pages7
JournalJournal of the American College of Cardiology
Volume45
Issue number8
DOIs
StatePublished - Apr 19 2005

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    Moses, J. W., Mehran, R., Nikolsky, E., Lasala, J. M., Corey, W., Albin, G., Hirsch, C., Leon, M. B., Russell, M. E., Ellis, S. G., & Stone, G. W. (2005). Outcomes with the paclitaxel-eluting stent in patients with acute coronary syndromes: Analysis from the TAXUS-IV trial. Journal of the American College of Cardiology, 45(8), 1165-1171. https://doi.org/10.1016/j.jacc.2004.10.074