Three-Year Outcome After Coronary Stenting Versus Bypass Surgery for the Treatment of Multivessel Disease

Abstract

on behalf of the Arterial Revascularization Therapy Study (ARTS) InvestigatorsBackground-The primary results of Arterial Revascularization Therapy Study reported a greater need for repeated revascularization after percutaneous coronary intervention with stenting (PCI). However, PCI was less expensive than coronary artery bypass grafting (CABG) and offered the same degree of protection against death, stroke, and myocardial infarction. Methods and Results-Patients with multivessel disease (nϭ1205) were randomly assigned to either CABG or PCI and followed up for up to 3 years. Survival rates without stroke or myocardial infarction were similar in each group at 1 year and 3 years (90.5% versus 91.4% for PCI versus CABG at 1 year and 87.2% versus 88.4% for PCI versus CABG at 3 years). However, the respective repeat revascularization rates were 21.2% and 26.7% at 1 and 3 years in patients allocated to PCI, compared with 3.8% and 6.6% in patients allocated to CABG (PϽ0.0001). Diabetes (PϽ0.0009) and maximal pressure for stent deployment (PϽ0.002) are the strongest independent predictors of events at 3 years after PCI, whereas left anterior descending coronary artery grafting (PϽ0.006) is the best predictor of event-free survival at 3 years after CABG. The incremental cost of surgery compared with PCI for an event-free patient was 19 257 € at 1 year but decreased to 10 492 € at 3 years. It remained at 142 391 € at 3 years when revascularization procedures were excluded in the efficacy end point, however. Conclusions-Three-year survival rates without stroke and myocardial infarction are identical in both groups, and the cost/benefit ratio of stenting is determined primarily by the increasing need for revascularization in the PCI group.

Evolução clínica pós-stent coronariano em pacientes submetidos a transplante de rim

“…These results are similar to the clinical restenosis rates of studies on drug-eluting stents in diabetic patients 19 . The use of a great number of stents per patient is similar to the use of approximately two stents per patient demonstrated in recent studies with drug-eluting stents in multivessel disease 20 .…”

Choosing Between Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting for Patients With Multivessel Disease

“…In the present issue of Circulation, Legrand et al 13 extend the results of the ARTS trial out to 3 years. The results are similar to the previously published results after 1 year of follow-up, except that the need for repeat revascularization continued to increase more in the stent than the CABG arm.…”

Influence of age on the clinical outcomes of coronary revascularisation for the treatment of patients with multivessel de novo coronary artery lesions: sirolimus-eluting stent vs. coronary artery bypass surgery and bare metal stent, insight from the multicentre randomised Arterial Revascularisation Therapy Study Part I (ARTS-I) and Part II (ARTS-II)

“…The primary endpoint was defined as the absence of any of the following major adverse cardiac and cerebral events (MACCE) within three years of inclusion in the trial: death (all-cause mortality), cerebrovascular accident, non-fatal myocardial infarction (MI), or any repeat revascularisation (either PCI or CABG). 12,14,15 MACCE rate during hospital stay and at three years is assessed according to hierarchical classification. In hierarchical classification, only the worst event was counted as an event.…”