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Coronary artery disease: Celecoxib after stent implantation can reduce the need for revascularisation of the target lesion

The adjunctive use of Celecoxib ( Celebrex ) for 6 months after stent implantation in patients with coronary artery disease is safe and can reduce the need for revascularisation of the target lesion.

In-vitro and animal experiments have shown that the cyclo-oxygenase 2 inhibitor Celecoxib can reduce formation of neointima within stents.

Researchers at Seoul National University College of Medicine, South Korea, assessed whether Celecoxib has similar effects in a clinical setting.

In a randomised two-centre trial, 274 patients who had angina pectoris or a positive stress test and who had native coronary artery lesions for which implantation of Paclitaxel-eluting stents was feasible, were enrolled.

All patients were given Acetylsalicylic acid ( Aspirin; 100 mg daily ) and Clopidogrel ( Plavix; 75 mg daily ); 136 patients were randomly assigned to receive Celecoxib ( 400 mg before the intervention, and 200 mg twice daily for 6 months after the procedure ).

The primary endpoint was late luminal loss on quantitative coronary angiography at 6 months after the intervention. Secondary endpoints were cardiac death, non-fatal myocardial infarction, and revascularisation of the target lesion.

At 6 months, mean in-stent late luminal loss was lower in the Celecoxib group ( 0.49 mm ) than in the control group ( 0.75 mm ) ( absolute difference 0.26 mm ).

Frequency of secondary outcomes at 6 months was also lower in the Celecoxib group, mainly because of a reduced need for revascularisation of the target lesion.
Revascularization was 15% among the controls and 5% among the Celecoxib patients.

In an accompanying comment, Francesco Pelliccia and Vincenzo Pasceri, at Ospedale San Filippo Neri in Rome, called the results impressive. They noted, however, that the restenosis rate was high for a study with drug-eluting stents and should therefore not be extrapolated to other patient populations.

Although Celecoxib might be beneficial even when given for a short time before and after coronary angioplasty, the safety of this drug in interventional cardiology should be confirmed by studies powered to assess the risk of myocardial infarction and cardiac death, Pelliccia and Pasceri said.

Source: The Lancet, 2007