title: Outcomes of paclitaxel-eluting stent implantation in patients with stenosis of the left anterior descending coronary artery.
abstract: OBJECTIVE
  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.
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.forename: Richard
authors.initials: R
authors.lastname: Shlofmitz
authors.forename: Stanley
authors.initials: S
authors.lastname: Katz
authors.forename: David
authors.initials: D
authors.lastname: Fish
authors.forename: Steven
authors.initials: S
authors.lastname: Martin
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Mary E
authors.initials: ME
authors.lastname: Russell
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D017239:Paclitaxel / Q000008:administration & dosage*; D011108:Polymers; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D011108:Polymers; D017239:Paclitaxel