Effects of Celecoxib on Restenosis After Coronary Intervention and Evolution of Atherosclerosis (Mini-COREA) Trial: Celecoxib, a Double-Edged Sword for Patients With Angina

Study Questions:

What is the impact of celecoxib on restenosis in patients undergoing percutaneous coronary intervention (PCI)?

Methods:

The authors performed a randomized trial of 3-month therapy of celecoxib in patients (n = 909) undergoing PCI with paclitaxel-eluting stent (PES) or zotarolimus-eluting stent (ZES). In the celecoxib group, 200 mg of celecoxib was given twice daily for 3 months after the procedure. The primary endpoint was in-stent late loss at 6 months.

Results:

Patients randomized to celecoxib had significantly lower late loss compared with controls (0.64 ± 0.54 vs. 0.55 ± 0.47 mm, p = 0.02). Reduction in late loss was independent of the stent type. There was a trend toward a reduction in clinically driven target lesion revascularization (TLR) in the celecoxib group (5.7 vs. 3.2%, log-rank p = 0.09), but there was no difference in the composite adverse cardiac event rate (composite of cardiac death, nonfatal myocardial infarction, and TLR; 8.6 vs. 7.7%, log-rank p = 0.84). Patients treated with celecoxib were more likely to suffer nonfatal myocardial infarction and cardiac death (1.6% vs. 0.2%, log rank p = 0.03).

Conclusions:

Therapy with celecoxib was associated with a reduction in late loss and a trend toward reduction in TLR, but at the cost of an increase in thrombotic events.

Perspective:

The use of celecoxib to reduce restenosis was prompted by the results of the COREA-TAXUS trial (the Effect Of Celecoxib on REstenosis after coronary Angioplasty with TAXUS stent), where this drug was associated with a reduction in DES restenosis. The results of the current study confirm the anti-restenotic benefit of celecoxib, but also raise concerns about an increased risk of thrombotic events. The increased risk of death and myocardial infarction with this drug has been highlighted in the past (Solomon SD, et al. Circulation 2008;117:2104-13), and this drug should be avoided in patients undergoing PCI.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Statins

Keywords: Paclitaxel, Myocardial Infarction, Atherosclerosis, Pyrazoles, Sirolimus, Angioplasty, Balloon, Coronary, Sulfonamides, Stents


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