Oral rapamycin after coronary bare-metal stent implantation to prevent restenosis: the Prospective, Randomized Oral Rapamycin in Argentina (ORAR II) Study.
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.
Rodriguez
Alfredo E
AE
Otamendi Hospital, Buenos Aires, Argentina. rodrigueza@sanatorio-otamendi.com.ar
Granada
Juan F
JF
Rodriguez-Alemparte
Máximo
M
Vigo
Cesar F
CF
Delgado
Juan
J
Fernandez-Pereira
Carlos
C
Pocovi
Antonio
A
Rodriguez-Granillo
Alfredo M
AM
Schulz
Daryl
D
Raizner
Albert E
AE
Palacios
Igor
I
O'Neill
William
W
Kaluza
Grzegorz L
GL
Stone
Gregg
G
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
D020533:Angiogenesis Inhibitors; D008670:Metals; D020123:Sirolimus