title: Randomized comparison of everolimus-eluting stents and sirolimus-eluting stents in patients with ST elevation myocardial infarction: RACES-MI trial.
abstract: OBJECTIVE
  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).
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Lorenzo
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Sauro
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Varricchio
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Capasso
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Tonino
authors.initials: T
authors.lastname: Lanzillo
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Fiore
authors.initials: F
authors.lastname: Manganelli
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Giannignazio
authors.initials: G
authors.lastname: Carbone
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lanni
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Pagliuca
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stanco
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosato
authors.affiliation: Department of Cardiology, University Medical Center St. Radboud, Nijmegen, the Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.affiliation: 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. Electronic address: giuseppe.deluca@med.unipmn.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003328:Coronary Thrombosis / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012008:Recurrence; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors; D000068338:Everolimus
keywords: ST-segment elevation myocardial infarction; everolimus-eluting stent(s); primary angioplasty; sirolimus-eluting stent(s); stent thrombosis