Author + information
- Received January 2, 2014
- Revision received February 7, 2014
- Accepted February 13, 2014
- Published online August 1, 2014.
- Emilio Di Lorenzo, MD, PhD∗,
- Rosario Sauro, MD∗,
- Attilio Varricchio, MD, PhD∗,
- Michele Capasso, MD∗,
- Tonino Lanzillo, MD∗,
- Fiore Manganelli, MD∗,
- Giannignazio Carbone, MD∗,
- Francesca Lanni, MD∗,
- Maria Rosaria Pagliuca, MD∗,
- Giovanni Stanco, MD∗,
- Giuseppe Rosato, MD∗,
- Harry Suryapranata, MD, PhD† and
- Giuseppe De Luca, MD, PhD‡,§∗ ()
- ∗Division of Cardiology, “S.G. Moscati”, Avellino, Italy
- †Department of Cardiology, University Medical Center St. Radboud, Nijmegen, the Netherlands
- ‡Division of Cardiology, Ospedale “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
- §Centro di Biotecnologie per la Ricerca Medica Applicata, Eastern Piedmont University, Novara, Italy
- ↵∗Reprint requests and correspondence:
Dr. Giuseppe De Luca, Division of Cardiology, Eastern Piedmont University, AOU Maggiore della Carità, Novara, Italy.
Objectives The aim of the current study was to compare everolimus-eluting stents (EES) with sirolimus-eluting stents (SES) in patients undergoing primary angioplasty.
Background Drug-eluting stents may offer benefits in terms of repeat revascularization. However, as shown for first-generation drug-eluting stents, they may be counterbalanced by a potential higher risk of stent thrombosis, especially among patients with ST-segment elevation myocardial infarction (STEMI). No data have been reported so far on the long-term benefits and safety of the new generation of drug-eluting stents in STEMI.
Methods Consecutive STEMI patients admitted within 12 h of symptom onset and undergoing primary angioplasty and stent implantation at a tertiary center with 24-h primary percutaneous coronary intervention capability were randomly assigned to SES or EES. The primary endpoint was a major adverse cardiac event at 3-year follow-up. The secondary endpoints were death, reinfarction, definite or probable stent thrombosis, and target vessel revascularization at 3-year follow-up. No patient was lost to follow-up.
Results From April 2007 to May 2009, 500 patients with STEMI were randomized to EES (n = 250) or SES (n = 250). No difference was observed in terms of baseline demographic and clinical characteristics between the groups. No difference was observed between the groups in terms of number of implanted stents per patient or total stent length. However, a larger reference diameter was observed with SES (3.35 ± 0.51 mm vs. 3.25 ± 0.51 mm, p = 0.001), whereas patients randomized to EES more often received glycoprotein IIb/IIIa inhibitors (54.4% vs. 42.4%, p = 0.006). Follow-up data were available in all patients (1,095 ± 159 days). No significant difference was observed between EES and SES in major adverse cardiac events (16% vs. 20.8%, adjusted hazard ratio [HR]: 0.75 [95% confidence interval (CI): 0.5 to 1.13], p = 0.17), cardiac death (4.4% vs. 5.6%, adjusted HR: 0.77 [95% CI: 0.35 to 1.71], p = 0.53), recurrent MI (6.4% vs. 10%, adjusted HR: 0.62 [95% CI: 0.33 to 1.16], p = 0.13), and target vessel revascularization (4.8% vs. 4.8%, adjusted HR: 1.00 [95% CI: 0.45 to 2.32], p = 0.99). However, EES was associated with a significant reduction in stent thrombosis (1.6% vs. 5.2%, adjusted HR: 0.3 [95% CI: 0.1 to 0.92], p = 0.035).
Conclusions This study shows that among STEMI patients undergoing primary angioplasty, EES has similar efficacy as SES, but is associated with a significant reduction in stent thrombosis. (Randomized Comparison of Everolimus Eluting Stents and Sirolimus Eluting Stent in Patients With ST Elevation Myocardial Infarction [RACES-MI]; NCT01684982)
- everolimus-eluting stent(s)
- primary angioplasty
- sirolimus-eluting stent(s)
- stent thrombosis
- ST-segment elevation myocardial infarction
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 2, 2014.
- Revision received February 7, 2014.
- Accepted February 13, 2014.
- American College of Cardiology Foundation