Objective: The 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 suggests that patients with disease of the proximal left anterior descending artery (LAD) may derive particular benefit from coronary artery bypass grafting (CABG). We therefore analyzed 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 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 nonfatal 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 revascularization than ARTS-II (5.3% vs. 13.1%, p=0.002), the overall composite adverse event rates (death, myocardial infarction, stroke or any repeat revascularization) 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.
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