title: Long-term results of the randomized comparison of everolimus-eluting stents and sirolimus-eluting stent in patients with ST elevation myocardial infarction (RACES-MI trial).
abstract: BACKGROUND
  Several concerns have emerged about the higher risk of very late stent thrombosis (ST) with first generation drug-eluting stent (DES), especially in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). New generation DES have demonstrated reduction in ST at mid-term follow-up, however no data are available on long-term follow-up. Therefore, the aim of this study was to report long-term results of the RACES-MI trial conducted to compare Everolimus-Eluting Stent (EES) vs Sirolimus-Eluting Stent (SES) in patients undergoing primary PCI.
  
  
  METHODS
  The RACES-MI trial enrolled consecutive STEMI patients admitted within 12h of symptom onset, undergoing primary PCI with stent implantation at a tertiary center with 24-hour primary PCI capability, who were randomly assigned to SES or EES. Primary endpoint of this analysis is major adverse cardiac events (MACE) at long-term follow-up. Secondary endpoints are 1) death; 2) reinfarction; 3) definite or probable ST; 4) target-vessel revascularization (TVR) at long-term 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 between the groups either in baseline clinical characteristics, in the number of implanted stent or total stent length per patient. 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 received Gp IIb-IIIa inhibitors more often (54.4% vs 42.4%, p=0.006). At long-term follow-up (2132±528 days), EES was associated with a significant reduction in MACE (23.8 vs 34.1%, adjusted p=0.028), ST (2.5% vs 7.7%, adjusted p=0.009), without any difference in death (8.7% vs 11.4%, adjusted p=0.47), reMI (9.3% vs 13.1%; adjusted p=0.18) and TVR (8.6% vs 12.3%, adjusted p=0.31).
  
  
  CONCLUSIONS
  This study shows that among STEMI patients undergoing primary PCI EES, as compared to SES, is associated with significant reduction in MACE and ST at long-term follow-up.
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: Michele
authors.initials: M
authors.lastname: Capasso
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: Tonino
authors.initials: T
authors.lastname: Lanzillo
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: Fiore
authors.initials: F
authors.lastname: Manganelli
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmieri
authors.affiliation: Division of Cardiology, "S.G. Moscati", Avellino, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Serino
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: Giuseppe
authors.initials: G
authors.lastname: Rosato
authors.affiliation: Department of Cardiology, UMC 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 (BRMA), Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@med.unipmn.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
mesh_terms: D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D000068338:Everolimus / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012008:Recurrence; D020123:Sirolimus / Q000494:pharmacology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus
keywords: EES; Primary angioplasty; SES; STEMI