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JAMES J. NAWARSKAS, PHARM.D., is Associate Professor of Pharmacy, College of Pharmacy, University of New Mexico (UNM), and LARRY A. OSBORN, M.D., FACC, FSCAI, is Professor of Medicine, School of Medicine, UNM, and Director, Cardiac Catheterization Laboratory, University of New Mexico Hospital, Albuquerque.

Address correspondence to Dr. Nawarskas at the College of Pharmacy, University of New Mexico, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131-0001 (jnawarskas{at}salud.unm.edu).

Purpose. Clinical information regarding paclitaxel-eluting coronary artery stents is reviewed. Summary. Restenosis is a significant complication of percutaneous coronary intervention. Coronary artery stenting has reduced restenosis compared with traditional balloon angioplasty, although restenosis still occurs with bare-metal coronary artery stents. The pathogenesis of in-stent restenosis is believed to involve smooth-muscle-cell proliferation and migration in response to vessel injury. A neointimal layer of extracellular matrix and collagen forms, which may impinge on the vessel lumen. Paclitaxel inhibits vascular smooth-muscle-cell proliferation and reduces neointimal mass. Local delivery of paclitaxel through a coronary stent has been shown to reduce restenosis rates and percent diameter stenosis and to produce other angiographic benefits compared with bare-metal stents. Fewer major adverse coronary events are seen with paclitaxel-eluting stents, predominantly because of a reduction in the need for target-vessel revascularization with minimal impact on rates of mortality and myocardial infarction (MI). The Taxus Express2 stent, the only approved paclitaxel-eluting stent in the United States, costs about three times as much as a bare-metal stent. Cost-effectiveness analyses are needed to determine if the Taxus stent is cost-effective in clinical practice. Conclusion. Paclitaxel-eluting stents reduce the rates of restenosis and target-vessel revascularization compared with bare-metal stents and have comparable effects on mortality and MI rates. Index terms: Antineoplastic agents; Coronary disease; Costs; Economics; Mechanism of action; Mortality; Paclitaxel; Restenosis; Stents

 

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