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
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.
|Keywords||all-comers, coronary artery bypass graft surgery, coronary stents, diabetes, sirolimus-eluting stent|
|Persistent URL||dx.doi.org/10.1016/j.jacc.2008.09.010, hdl.handle.net/1765/29780|
Daemen, J., Kuck, K.H., Miguel, C.M., Legrand, V.M.G., Vrolix, M.C., Carrié, D., … Serruys, P.W.J.C.. (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), 1957–1967. doi:10.1016/j.jacc.2008.09.010