Myocardial infarction paclitaxel

The pivotal US trial for the Paclitaxel stent was the TAXUS IV trial, which enrolled 1,314 patients with single de novo coronary lesions (Length 10-28 mm and diameter 2.5-3.75 mm) [67] (Fig. 5.7). Target vessel revascularization based on ischemic symptoms was reduced from 12 to 4.7% p < 0.001). The rate of restenosis by angiography was considerable lower (7.9% versus 26.6% p < 0.001), with no difference in the rate of cardiac death, myocardial infarction, or stent thrombosis. 

Stone GW, Ellis SG, Colombo A, Dawkins KD, Grube E, Cutlip DE, Friedman M, Bairn DS, Koglin J. Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation. Circulation 2007 Jun 5 115(22) 2842-2847. 

Hofma SH, Ong AT Aoki J, et al. One year clinical follow up of paclitaxel eluting stents for acute myocardial infarction compared with sirolimus eluting stents, Heart 2005 91 (9) I 176-1 180. 

Paclitaxel An++, C+, M+, N+ Severe hypersensitivity reactions, including death, reported. Hypotension, bradycardia, ECG abnormalities, conduction abnomaalities may occur. Fatal myocardial Infarction 15 h into infusion reported. 

The authors of a review of the cardiac toxicity associated with paclitaxel treatment concluded that the overall incidence of serious cardiac events is low (0.1%). The causal relation of paclitaxel to atrial and ventricular dysrhythmias and cardiac ischemia is not entirely clear [32 ]. Reported events include ventricular tachycardia, Mobitz I (Wenckebach syndrome), Mobitz U atrioventricular block, complete atrioventricular block (requiring pacemaker insertion), acute myocardial infarction, supraventricular tachycardia, and atrial fibrillation. 

---