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Multivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial.
J Am Coll Cardiol. 2008 Dec 09; 52(24):1957-67.JACC

Abstract

OBJECTIVES

The purpose of this study was to assess the 3-year outcome of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SES) in patients who had multivessel coronary artery disease with and without diabetes mellitus.

BACKGROUND

The optimal method of revascularization in diabetic patients remains in dispute.

METHODS

The ARTS-II (Arterial Revascularization Therapies Study-Part II) trial is a single-arm study (n = 607) that included 159 diabetic patients treated with SES whose 3-year clinical outcome was compared with that of the historical diabetic and nondiabetic arms of the randomized ARTS-I trial (n = 1,205, including 96 diabetic patients in the CABG arm and 112 in the PCI arm).

RESULTS

At 3 years, among nondiabetic patients, the incidence of the primary composite of death, CVA, myocardial infarction (MI), and repeat revascularization (major adverse cardiac and cerebrovascular events [MACCE]), was significantly lower in ARTS-II than in ARTS-I PCI (adjusted odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.26 to 0.64) and similar to ARTS-I CABG. The ARTS-II patients were at significantly lower risk for death, CVA, and MI as compared with both the ARTS-I PCI (adjusted OR: 0.55; 95% CI: 0.34 to 0.91) and ARTS-I CABG patients (adjusted OR: 0.56; 95% CI: 0.35 to 0.92). Among diabetic patients, the incidence of MACCE in ARTS-II was similar to that of both PCI and CABG in ARTS-I. Conversely, the incidence of death, CVA, and MI was significantly lower in ARTS-II than in ARTS-I PCI (adjusted OR: 0.67; 95% CI: 0.27 to 1.65) and was similar to that of ARTS-I CABG.

CONCLUSIONS

At 3 years, PCI using SES for patients with multivessel coronary artery disease seems to be safer and more efficacious than PCI using bare-metal stents, irrespective of the diabetic status of the patient. Hence, PCI using SES appears to be a valuable alternative to CABG for both diabetic and nondiabetic patients.

Authors+Show Affiliations

Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19055986

Citation

Daemen, Joost, et al. "Multivessel Coronary Revascularization in Patients With and Without Diabetes Mellitus: 3-year Follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) Trial." Journal of the American College of Cardiology, vol. 52, no. 24, 2008, pp. 1957-67.
Daemen J, Kuck KH, Macaya C, et al. Multivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial. J Am Coll Cardiol. 2008;52(24):1957-67.
Daemen, J., Kuck, K. H., Macaya, C., LeGrand, V., Vrolix, M., Carrie, D., Sheiban, I., Suttorp, M. J., Vranckx, P., Rademaker, T., Goedhart, D., Schuijer, M., Wittebols, K., Macours, N., Stoll, H. P., & Serruys, P. W. (2008). Multivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial. Journal of the American College of Cardiology, 52(24), 1957-67. https://doi.org/10.1016/j.jacc.2008.09.010
Daemen J, et al. Multivessel Coronary Revascularization in Patients With and Without Diabetes Mellitus: 3-year Follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) Trial. J Am Coll Cardiol. 2008 Dec 9;52(24):1957-67. PubMed PMID: 19055986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial. AU - Daemen,Joost, AU - Kuck,Karl Heinz, AU - Macaya,Carlos, AU - LeGrand,Victor, AU - Vrolix,Maarten, AU - Carrie,Didier, AU - Sheiban,Imad, AU - Suttorp,Maarten Jan, AU - Vranckx,Pascal, AU - Rademaker,Tessa, AU - Goedhart,Dick, AU - Schuijer,Monique, AU - Wittebols,Kristel, AU - Macours,Nathalie, AU - Stoll,Hans Peter, AU - Serruys,Patrick W, AU - ,, PY - 2008/06/16/received PY - 2008/08/14/revised PY - 2008/09/02/accepted PY - 2008/12/6/pubmed PY - 2009/1/16/medline PY - 2008/12/6/entrez SP - 1957 EP - 67 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 52 IS - 24 N2 - OBJECTIVES: The purpose of this study was to assess the 3-year outcome of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SES) in patients who had multivessel coronary artery disease with and without diabetes mellitus. BACKGROUND: The optimal method of revascularization in diabetic patients remains in dispute. METHODS: The ARTS-II (Arterial Revascularization Therapies Study-Part II) trial is a single-arm study (n = 607) that included 159 diabetic patients treated with SES whose 3-year clinical outcome was compared with that of the historical diabetic and nondiabetic arms of the randomized ARTS-I trial (n = 1,205, including 96 diabetic patients in the CABG arm and 112 in the PCI arm). RESULTS: At 3 years, among nondiabetic patients, the incidence of the primary composite of death, CVA, myocardial infarction (MI), and repeat revascularization (major adverse cardiac and cerebrovascular events [MACCE]), was significantly lower in ARTS-II than in ARTS-I PCI (adjusted odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.26 to 0.64) and similar to ARTS-I CABG. The ARTS-II patients were at significantly lower risk for death, CVA, and MI as compared with both the ARTS-I PCI (adjusted OR: 0.55; 95% CI: 0.34 to 0.91) and ARTS-I CABG patients (adjusted OR: 0.56; 95% CI: 0.35 to 0.92). Among diabetic patients, the incidence of MACCE in ARTS-II was similar to that of both PCI and CABG in ARTS-I. Conversely, the incidence of death, CVA, and MI was significantly lower in ARTS-II than in ARTS-I PCI (adjusted OR: 0.67; 95% CI: 0.27 to 1.65) and was similar to that of ARTS-I CABG. CONCLUSIONS: At 3 years, PCI using SES for patients with multivessel coronary artery disease seems to be safer and more efficacious than PCI using bare-metal stents, irrespective of the diabetic status of the patient. Hence, PCI using SES appears to be a valuable alternative to CABG for both diabetic and nondiabetic patients. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/19055986/Multivessel_coronary_revascularization_in_patients_with_and_without_diabetes_mellitus:_3_year_follow_up_of_the_ARTS_II__Arterial_Revascularization_Therapies_Study_Part_II__trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03176-8 DB - PRIME DP - Unbound Medicine ER -