Five year clinical effect of coronary stenting and coronary artery bypass grafting in renal insufficient patients with multivessel coronary artery disease: Insights from ARTS trial

Aims: To compare coronary stent implantation and bypass surgery for multivessel coronary disease in patients with renal insufficiency. Methods and results: In the ARTS trial, 142 moderate renal insufficient patients (Ccr < 60 mL/min) with multivessel coronary disease were randomly assigned to stent implantation (n = 69) or CABG (n = 73). At 5 years, there was no significant difference between the two groups in terms of mortality (14.5% in the stent group vs. 12.3% in the CABG group, P = 0.81), or combined endpoint of death, cerebrovascular accident (CVA), or myocardial infarction (MI) (30.4% in the stent group vs. 23.3% in the CABG group, P = 0.35). Among patients who survived without CVA or MI, 18.8% in the stent group underwent a second revascularization procedure when compared with 8.2% in the surgery group (P = 0.08). The event-free survival at 5 years was 50.7% in the stent group and 68.5% in the surgery group (P = 0.04). Conclusion: At 5 years, the differences in mortality and combined incidence of death, CVA, and MI between coronary stenting and surgery did not reach statistically significant level. However, the occurrence of MACCE in the stent group was higher than in the CABG group, mainly driven by the higher incidence of repeat revascularization in the stent group.