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(Circulation. 2004;109:1079-1081.)
© 2004 American Heart Association, Inc.

Focused Perspectives

Choosing Between Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting for Patients With Multivessel Disease

What Can We Learn From the Arterial Revascularization Therapy Study (ARTS)?

Peter B. Berger, MD; Michael H. Sketch, Jr, MD; Robert M. Califf, MD

From the Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC.

Correspondence to Peter Berger, MD, Division of Cardiology/Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705. E-mail berge023@mc.duke.edu

Key Words: Focused Perspectives • bypass • revascularization • coronary disease • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The ARTS trial was one of 11 randomized trials comparing an initial strategy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in the treatment of patients with multivessel coronary artery disease.^1–11 Six of these trials used balloon angioplasty in the PCI arm,^1–6 whereas the 5 most recent trials (of which ARTS was the largest, with 1205 patients) used stents in the PCI arm.^7–11 The results of these 11 trials were concordant in that the frequency of death and myocardial infarction in both arms was similar, although freedom from repeat procedures and angina was superior in the surgical arms. Few trials included stroke as an end point (the exclusion of stroke would generally favor the CABG arm); in the ARTS trial, however, the combined end point of survival free of myocardial infarction or stroke was similar in the 2 groups at 3 years (87.2% for PCI versus 88.4% for CABG, P=NS), whereas the composite end point, which included repeat revascularization, markedly favored CABG.

See p 1114

	Balloon Angioplasty Versus Stent Placement

 
The results of the trials using balloon angioplasty and stents differed in 2 important ways. In the balloon angioplasty trials, the frequency with which urgent or emergency CABG was required in the PCI arm during the index hospitalization ranged from 5% to 10%, whereas in the stent trials, fewer than 1% of PCI patients required urgent or emergency CABG. The second difference relates to the frequency of restenosis in the PCI arms of the trials. Those trials in which stents were . . . [Full Text of this Article]

Related Article:

Three-Year Outcome After Coronary Stenting Versus Bypass Surgery for the Treatment of Multivessel Disease

Victor M.G. Legrand, Patrick W. Serruys, Felix Unger, Ben A. van Hout, Mathias C.M. Vrolix, Geert M.P. Fransen, Torsten Toftegaard Nielsen, Peter Kildeberg Paulsen, Ricardo Seabra Gomes, João M.G. de Queiroz e Melo, José P. Marques dos Santos Neves, Wietze Lindeboom, Bianca Backx on behalf of the Arterial Revascularization Therapy Study (ARTS) Investigators
Circulation 2004 109: 1114-1120. [Abstract] [Full Text]

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