The effect of completeness of revascularization on event-free survival at one year in the ARTS trial.
OBJECTIVE
We sought to assess the relationship between completeness of revascularization and adverse events at one year in the ARTS (Arterial Revascularization Therapies Study) trial.


BACKGROUND
There is uncertainty to what extent degree of completeness of revascularization, using up-to-date techniques, influences medium-term outcome.


METHODS
After consensus between surgeon and cardiologist regarding the potential for equivalence in the completeness of revascularization, 1,205 patients with multivessel disease were randomly assigned to either bypass surgery or stent implantation. All baseline and procedural angiograms and surgical case-record forms were centrally assessed for completeness of revascularization.


RESULTS
Of 1,205 patients randomized, 1,172 underwent the assigned treatment. Complete data for review were available in 1,143 patients (97.5%). Complete revascularization was achieved in 84.1% of the surgically treated patients and 70.5% of the angioplasty patients (p < 0.001). After one year, the stented angioplasty patients with incomplete revascularization showed a significantly lower event-free survival than stented patients with complete revascularization (i.e., freedom from death, myocardial infarction, cerebrovascular accident and repeat revascularization) (69.4% vs. 76.6%; p < 0.05). This difference was due to a higher incidence of subsequent bypass procedures (10.0% vs. 2.0%; p < 0.05). Conversely, at one year, bypass surgery patients with incomplete revascularization showed only a marginally lower event-free survival rate than those with complete revascularization (87.8% vs. 89.9%).


CONCLUSIONS
Complete revascularization was more frequently accomplished by bypass surgery than by stent implantation. One year after bypass, there was no significant difference in event-free survival between surgically treated patients with complete revascularization and those with incomplete revascularization, but patients randomized to stenting with incomplete revascularization had a greater need for subsequent bypass surgery.
van den Brand
Marcel J B M
MJ
Thoraxcenter, Department of Cardiology, University Hospital Dijkzigt, Rotterdam, The Netherlands. vandenbrand@card.azr.nl
Rensing
Benno J W M
BJ
Morel
Marie-angèle M
MA
Foley
David P
DP
de Valk
Vincent
V
Breeman
Arno
A
Suryapranata
Harry
H
Haalebos
Maximiliaan M P
MM
Wijns
William
W
Wellens
Francis
F
Balcon
Rafael
R
Magee
Patrick
P
Ribeiro
Expedito
E
Buffolo
Enio
E
Unger
Felix
F
Serruys
Patrick W
PW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011897:Random Allocation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome