title: A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease.
abstract: BACKGROUND
  Restenosis after coronary stenting necessitates repeated percutaneous or surgical revascularization procedures. The delivery of paclitaxel to the site of vascular injury may reduce the incidence of neointimal hyperplasia and restenosis.
  
  
  METHODS
  At 73 U.S. centers, we enrolled 1314 patients who were receiving a stent in a single, previously untreated coronary-artery stenosis (vessel diameter, 2.5 to 3.75 mm; lesion length, 10 to 28 mm) in a prospective, randomized, double-blind study. A total of 652 patients were randomly assigned to receive a bare-metal stent, and 662 to receive an identical-appearing, slow-release, polymer-based, paclitaxel-eluting stent. Angiographic follow-up was prespecified at nine months in 732 patients.
  
  
  RESULTS
  In terms of base-line characteristics, the two groups were well matched. Diabetes mellitus was present in 24.2 percent of patients; the mean reference-vessel diameter was 2.75 mm, and the mean lesion length was 13.4 mm. A mean of 1.08 stents (length, 21.8 mm) were implanted per patient. The rate of ischemia-driven target-vessel revascularization at nine months was reduced from 12.0 percent with the implantation of a bare-metal stent to 4.7 percent with the implantation of a paclitaxel-eluting stent (relative risk, 0.39; 95 percent confidence interval, 0.26 to 0.59; P<0.001). Target-lesion revascularization was required in 3.0 percent of the group that received a paclitaxel-eluting stent, as compared with 11.3 percent of the group that received a bare-metal stent (relative risk, 0.27; 95 percent confidence interval, 0.16 to 0.43; P<0.001). The rate of angiographic restenosis was reduced from 26.6 percent to 7.9 percent with the paclitaxel-eluting stent (relative risk, 0.30; 95 percent confidence interval, 0.19 to 0.46; P<0.001). The nine-month composite rates of death from cardiac causes or myocardial infarction (4.7 percent and 4.3 percent, respectively) and stent thrombosis (0.6 percent and 0.8 percent, respectively) were similar in the group that received a paclitaxel-eluting stent and the group that received a bare-metal stent.
  
  
  CONCLUSIONS
  As compared with bare-metal stents, the slow-release, polymer-based, paclitaxel-eluting stent is safe and markedly reduces the rates of clinical and angiographic restenosis at nine months.
authors.affiliation: Cardiovascular Research Foundation and Lenox Hill Heart and Vascular Institute, New York 10022, USA. gstone@crf.org
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: James
authors.initials: J
authors.lastname: Hermiller
authors.forename: Charles
authors.initials: C
authors.lastname: O'Shaughnessy
authors.forename: James Tift
authors.initials: JT
authors.lastname: Mann
authors.forename: Mark
authors.initials: M
authors.lastname: Turco
authors.forename: Ronald
authors.initials: R
authors.lastname: Caputo
authors.forename: Patrick
authors.initials: P
authors.lastname: Bergin
authors.forename: Joel
authors.initials: J
authors.lastname: Greenberg
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Popma
authors.forename: Mary E
authors.initials: ME
authors.lastname: Russell
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017239:Paclitaxel / Q000008:administration & dosage*; D011108:Polymers; D012306:Risk; D015607:Stents
chemical_list: D011108:Polymers; D017239:Paclitaxel