Sirolimus-eluting stents, bare metal stents or coronary artery bypass grafting for patients with multivessel disease including involvement of the proximal left anterior descending artery: analysis of the Arterial Revascularization Therapies study part 2 (ARTS-II)
- N Kukreja1,
- P W Serruys1,
- B De Bruyne2,
- A Colombo3,
- C Macaya4,
- G Richardt5,
- J Fajadet6,
- C Hamm7,
- D Goedhart8,
- N Macours9,
- H P Stoll9
- 1Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- 2Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
- 3San Raffaele Hospital, Milan, Italy
- 4Hospital Clinico San Carlos, Madrid, Spain
- 5Segeberger Kliniken, Bad Segeberg, Germany
- 6Clinique Pasteur, Toulouse, France
- 7Kerckhof-Klinik, Bad Nauheim, Germany
- 8Cardialysis BV, Rotterdam, The Netherlands
- 9Cordis Clinical Research EMEA, Waterloo, Belgium
- Professor P W Serruys, Thoraxcenter, Ba-583, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; p.w.j.c.serruys{at}erasmusmc.nl
- Accepted 10 March 2009
- Published Online First 19 March 2009
Abstract
Objective: The The Arterial Revascularization Therapies Study (ARTS)-II trial found no differences in survival or overall adverse events between sirolimus-eluting stents (SES) and the surgical arm of ARTS-I. Nevertheless, existing data suggest that patients with disease of the proximal left anterior descending artery (LAD) may derive particular benefit from coronary artery bypass grafting (CABG). We therefore analysed the clinical outcome of patients in ARTS-I and ARTS-II with proximal LAD involvement.
Design: Multicentre observational study.
Setting: Forty-five European academic hospitals.
Patients: Patients with multivessel coronary artery disease.
Interventions: Patients in ARTS-II with proximal LAD disease treated with SES (289/607, 48%) were compared with 187/600 (31%) bare metal stent patients (ARTS-I BMS) and 206/605 (34%) surgical patients (ARTS-I CABG) with proximal LAD involvement from ARTS-I.
Main outcome measures: Major adverse cardiac and cerebrovascular events after 3 years.
Results: The Arterial Revascularization Therapies study part 2 (ARTS-II) subgroup had better survival than both ARTS-I groups (ARTS-II 98.6% vs ARTS-I BMS 95.7%, p = 0.05 and vs ARTS-I CABG 94.7%, p = 0.01) and lower rates of the hard clinical composite endpoint of death or non-fatal myocardial infarction (ARTS-II 3.1% vs ARTS-I BMS 9.6%, p = 0.002 and vs ARTS-I CABG 9.7%, p = 0.002). Although the ARTS-I CABG patients had a lower need for repeat revascularisation than ARTS-II (5.3% vs 13.1%, p = 0.002), the overall composite adverse event rates (death, myocardial infarction, stroke or any repeat revascularisation) were not significantly different between the ARTS-I CABG and ARTS-II patients (15.0% vs 18.0%, p = 0.4).
Conclusions: SES are not inferior to CABG or bare metal stents for the treatment of patients with multivessel coronary disease including involvement of the proximal LAD.
Footnotes
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Funding: The ARTS-II trial was sponsored by Cordis EMEA, a Johnson & Johnson company.
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Competing interests: NM and HPS are employees of Cordis EMEA, a Johnson & Johnson company.
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Ethics approval: Ethics approval was provided by the ethics committee of each participating site.
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Patient consent: Obtained.
