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European Heart Journal Advance Access originally published online on April 28, 2005
European Heart Journal 2005 26(15):1488-1493; doi:10.1093/eurheartj/ehi288
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

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

Jiro Aoki1, Andrew T.L. Ong1, Angela Hoye1, Lex A. van Herwerden1, J. Eduardo Sousa2, Adib Jatene3, Johannes J.R.M. Bonnier4, Jacques P.M.A. Schönberger4, Nigel Buller5, Robert Bonser5, Wietze Lindeboom6, Felix Unger7 and Patrick W. Serruys1,*

1Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
2Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
3Hospital do Coracao, Sao Paulo, Brazil
4Catharina Ziekenhuis, Eindhoven, The Netherlands
5The Queen Elisabeth Hospital, Birmingham, UK
6Cardialysis, Rotterdam, The Netherlands
7University Klinik für Herzchirurgie, Salzburg, Austria

Received 2 November 2004; revised 20 February 2005; accepted 24 March 2005; online publish-ahead-of-print 28 April 2005.

* Corresponding author. Tel: +31 10 4635269; fax: +31 10 4639154. E-mail address: p.w.j.c.serruys{at}erasmusmc.nl

See page 1456 for the editorial comment on this article (doi:10.1093/eurheartj/ehi332)

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.

Key Words: Stent • Coronary artery bypass • Renal insufficiency


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