Aug. 22, 2007 Adjunctive use of the COX-2* inhibitor celcoxib after stent implantation in patients with coronary artery disease is safe and can reduce the need for revascularisation of the target lesion, conclude authors of an article published in the recent cardiology special issue of The Lancet.
But an accompanying comment warns that clinical trials suggest long-term use of celecoxib can expose patients to an additional risk of heart attack.
Dr Hyo-Soo Kim, Seoul National University Hospital, Seoul, South Korea and colleagues have published the results of the COREA-TAXUS trial, which aimed to test whether the COX-2 inhibitor celecoxib could prevent the formation of smooth muscle tissue (neointima) within stents, which can lead to narrowing and eventually re-blockage of the lumen of the stent (restenosis).
They studied 274 patients, all of whom were given aspirin (100mg) daily and clopidogrel (75mg daily). Of these, 136 were randomly assigned to receive celecoxib (400mg before the stent implantation, and then 200mg twice daily for 6 months after the procedure). The in-stent lumen diameter of all patients was measured using a coronary angiography six months after stent implantation.
The researchers found that the average reduction on in-stent luminal diameter was 0.49mm in the celecoxib group and 0.75mm in the control group, meaning that celecoxib reduced the luminal reduction by 35%. There was also a decreased need for target-lesion revascularisation in the celecoxib group.
The authors say: “These data suggest that the adjunctive use of celecoxib for 6 months after stent implantation in patients with coronary artery is safe.” They add that unlike with another COX-2 inhibitor rofecoxib, celecoxib does not increase the risk of cardiovascular events. They say: “Administration of celecoxib for 6 months does not seem to increase the risk of adverse cardiac events in the intermediate term when used with dual anti-platelet therapy. We will be interested to see the 2-5 year follow-up results of this cohort.”
In the accompanying comment, Drs Francesco Pelliccia and Vincenzo Pasceri, Interventional Cardiology Unit, Ospedale San Filippo Neri, Rome, Italy say that the safety of celecoxib needs to be confirmed by studies to assess risk of heart attack and cardiac death, and that gastrointestinal tolerability of celecoxib in combination with aspirin and clopidogrel could also be a drawback.
However the comment authors conclude: “The study by Koo and colleagues underscores that systemic therapy might still have a role in prevention of restenosis, even in the era of drug-eluting stents.”
*A COX-2 selective inhibitor is a form of Non-steroidal anti-inflammatory drug (NSAID) that directly targets COX-2, an enzyme responsible for inflammation and pain.
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