Objectives: The aim of this study was to compare 10-year clinical outcomes of titanium-nitride-oxide-coated (TiNO)-stent versus permanent polymer everolimus-eluting (EES), for the primary endpoint of major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS).

Background: Previous trials with ACS patients have demonstrated non-inferiority of TiNO-stents compared with EES for clinical events up to 5-year follow-up. Long-term data from randomized clinical stent trials are scarce.

Methods: BASE-ACS trial randomized 827 ACS patients to receive either TiNO-stent or EES in a 1:1 fashion. The primary endpoint was MACE: a composite of cardiac death, non-fatal myocardial infarction (MI) or ischemia-driven target lesion revascularization (TLR).

Results: MACE was significantly lower in the TiNO group compared to EES group (19.2 % vs. 28.3 %; HR 0.72; CI 0.53-0.99; p = 0.04), driven mainly by reduction in MI (8.5 % vs. 13.9 %; HR 0.59; CI 0.37-0.93; p = 0.02) and cardiac death (3.4 % vs. 7.2 %; HR 0.55; CI 0.27-1.14; p = 0.09 (NS). The rate of TLR tended to be less frequent in the TiNO group (10.2 % vs. 15.1 %; HR 0.73; CI 0.48-1.12; p = 0.15 (NS). The rate of definite stent thrombosis was significantly less frequent in the TiNO group (1.8 % vs. 5.4 %; HR 0.32; CI 0.13-0.81; p = 0.01.

Conclusions: At 10-year follow-up, the rate of MACE was significantly lower in ACS patients treated with TiNO-stents compared to patients treated with EES.