CLINICAL STUDY: REVASCULARIZATION
The effect of completeness of revascularization on event-free survival at one year in the arts trial
Marcel J. B. M. van den Brand, MD*,*,
Benno J. W. M. Rensing, MD*,
Marie-angèle M. Morel, BSc ,
David P. Foley, MD*,
Vincent de Valk, PhD,
Arno Breeman, MD ,
Harry Suryapranata, MD, FACC,
Maximiliaan M. P. Haalebos, MD,
William Wijns, MD ,
Francis Wellens, MD,
Rafael Balcon, MD, FACC||,
Patrick Magee, MD, FACC||,
Expedito Ribeiro, MD¶,
Enio Buffolo, MD¶,
Felix Unger, MD, FACC# and
Patrick W. Serruys, MD, FACC*
* Thoraxcenter, Department of Cardiology, University Hospital Dijkzigt, Rotterdam, The Netherlands
Cardialysis, Rotterdam, The Netherlands
Isala Klinieken, locatie Weezenlanden, Zwolle, The Netherlands
Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
|| London Chest Hospital, London, United Kingdom
¶ Incor, The Heart Institute of the University of São Paulo, São Paulo, Brazil
# Klinik für Herzchirurgie, Landeskliniken, Salzburg, Austria
Manuscript received April 13, 2001;
revised manuscript received November 5, 2001,
accepted November 16, 2001.
* Reprint requests and correspondence: Dr. Marcel van den Brand, Thoraxcenter Bd 408, University Hospital Rotterdam, Dijkzigt, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
vandenbrand{at}card.azr.nl
OBJECTIVES: We sought to assess the relationship between completeness of revascularization and adverse events at one year in the ARTS (Arterial Revascularization Therapies Study) trial.
BACKGROUND: There is uncertainty to what extent degree of completeness of revascularization, using up-to-date techniques, influences medium-term outcome.
METHODS: After consensus between surgeon and cardiologist regarding the potential for equivalence in the completeness of revascularization, 1,205 patients with multivessel disease were randomly assigned to either bypass surgery or stent implantation. All baseline and procedural angiograms and surgical case-record forms were centrally assessed for completeness of revascularization.
RESULTS: Of 1,205 patients randomized, 1,172 underwent the assigned treatment. Complete data for review were available in 1,143 patients (97.5%). Complete revascularization was achieved in 84.1% of the surgically treated patients and 70.5% of the angioplasty patients (p < 0.001). After one year, the stented angioplasty patients with incomplete revascularization showed a significantly lower event-free survival than stented patients with complete revascularization (i.e., freedom from death, myocardial infarction, cerebrovascular accident and repeat revascularization) (69.4% vs. 76.6%; p < 0.05). This difference was due to a higher incidence of subsequent bypass procedures (10.0% vs. 2.0%; p < 0.05). Conversely, at one year, bypass surgery patients with incomplete revascularization showed only a marginally lower event-free survival rate than those with complete revascularization (87.8% vs. 89.9%).
CONCLUSIONS: Complete revascularization was more frequently accomplished by bypass surgery than by stent implantation. One year after bypass, there was no significant difference in event-free survival between surgically treated patients with complete revascularization and those with incomplete revascularization, but patients randomized to stenting with incomplete revascularization had a greater need for subsequent bypass surgery.
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Abbreviations and Acronyms
| | ARTS | | ARTS | | Arterial Revascularization Therapies Study | | LAD | | left anterior descending coronary artery | | LCx | | left circumflex coronary artery | | RCA | | right coronary artery |
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