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.
PY - 2008/12/9
Y1 - 2008/12/9
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.
AB - 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.
KW - all-comers
KW - coronary artery bypass graft surgery
KW - coronary stents
KW - diabetes
KW - sirolimus-eluting stent
UR - https://www.scopus.com/pages/publications/56849096301
U2 - 10.1016/j.jacc.2008.09.010
DO - 10.1016/j.jacc.2008.09.010
M3 - Article
C2 - 19055986
AN - SCOPUS:56849096301
SN - 0735-1097
VL - 52
SP - 1957
EP - 1967
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 24
ER -
