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European Heart Journal Advance Access published online on April 28, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi288
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received November 2, 2004
Revised February 20, 2005
Accepted March 24, 2005

Clinical research

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 Aoki 1, Andrew T.L. Ong 1, Angela Hoye 1, Lex A. van Herwerden 1, J. Eduardo Sousa 2, Adib Jatene 3, Johannes J.R.M. Bonnier 4, Jacques P.M.A. Schönberger 4, Nigel Buller 5, Robert Bonser 5, Wietze Lindeboom 6, Felix Unger 7, and Patrick W. Serruys 1*

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

* To whom correspondence should be addressed.
Patrick W. Serruys, E-mail: p.w.j.c.serruys{at}erasmusmc.nl


  Abstract

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.

Keywords: Stent; Coronary artery bypass; Renal insufficiency.
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