title: Oral rapamycin after coronary bare-metal stent implantation to prevent restenosis: the Prospective, Randomized Oral Rapamycin in Argentina (ORAR II) Study.
abstract: OBJECTIVE
  The purpose of this study was to assess the role of oral rapamycin in decreased restenosis after bare metal stent implantation.
  
  
  BACKGROUND
  Small observational studies suggest that the administration of oral rapamycin reduces angiographic restenosis after bare metal stent implantation.
  
  
  METHODS
  Between September 2003 and September 2004, 100 patients were randomized to either oral rapamycin (6-mg loading dose given 2.7 h before intervention followed by 3 mg/day for 14 days) plus diltiazem 180 mg/day or no therapy after the implantation of a coronary bare metal stent design. The primary study end point was incidence of angiographic binary restenosis and late loss at nine months. The secondary end points were target lesion revascularization, target vessel revascularization, and incidence of major adverse cardiovascular events at 1 year.
  
  
  RESULTS
  Angiographic follow-up was completed in 87% of patients. In the rapamycin group, the drug was well tolerated (26% minor side effects) and was maintained in 96% of patients. At 9 months, the in-segment binary restenosis was reduced by 72% (11.6% rapamycin vs. 42.8% no-therapy group, p = 0.001) and the in-stent binary restenosis was reduced by 65% (12% rapamycin vs. 34.6% no-therapy group, p = 0.009). The in-segment late loss was also significantly reduced with oral therapy (0.66 vs. 1.13 mm, respectively; 43% reduction, p < 0.001). At 1 year, patients in the oral rapamycin group also showed a significantly lower incidence of target vessel revascularization (8.3% vs. 38%, respectively, p < 0.001), target lesion revascularization (7.6% vs. 37.2%, respectively, p < 0.001), and major adverse cardiovascular events (20% vs. 44%, respectively, p = 0.018).
  
  
  CONCLUSIONS
  This randomized, controlled, and unblinded study showed that the administration of oral rapamycin during 14 days after stent implantation significantly reduces angiographic and clinical parameters of restenosis.
authors.affiliation: Otamendi Hospital, Buenos Aires, Argentina. rodrigueza@sanatorio-otamendi.com.ar
authors.forename: Alfredo E
authors.initials: AE
authors.lastname: Rodriguez
authors.forename: Juan F
authors.initials: JF
authors.lastname: Granada
authors.forename: Máximo
authors.initials: M
authors.lastname: Rodriguez-Alemparte
authors.forename: Cesar F
authors.initials: CF
authors.lastname: Vigo
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernandez-Pereira
authors.forename: Antonio
authors.initials: A
authors.lastname: Pocovi
authors.forename: Alfredo M
authors.initials: AM
authors.lastname: Rodriguez-Granillo
authors.forename: Daryl
authors.initials: D
authors.lastname: Schulz
authors.forename: Albert E
authors.initials: AE
authors.lastname: Raizner
authors.forename: Igor
authors.initials: I
authors.lastname: Palacios
authors.forename: William
authors.initials: W
authors.lastname: O'Neill
authors.forename: Grzegorz L
authors.initials: GL
authors.lastname: Kaluza
authors.forename: Gregg
authors.initials: G
authors.lastname: Stone
mesh_terms: D000284:Administration, Oral; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D015607:Stents; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D008670:Metals; D020123:Sirolimus