Comparison of bypass surgery and stenting for the treatment of multivessel disease: results from the ARTS trial in Israel.
BACKGROUND
The Arterial Revascularization Therapies Study was a multicenter, randomized trial designed to compare percutaneous coronary intervention with stenting versus coronary artery bypass graft surgery in 1,205 patients with multivessel coronary artery disease. The most appropriate type of treatment for these patients is still a matter of considerable debate.


OBJECTIVE
To evaluate the clinical characteristics of patients enrolled in the ARTS trial in Israel in comparison to those worldwide, and to assess the 1 year outcome in these patients.


METHODS
Between April 1997 and June 1998, a total of 1,205 patients with multivessel coronary artery disease, who were considered to be equally treatable with both modalities, were randomized to either stenting (n = 600) or CABG (n = 605) at 67 centers around the world. In Israel, 53 patients at four participating medical centers were randomized to either PCI with stents (n = 27) or CABG (n = 26).


RESULTS
Clinical and angiographic characteristics were similar in the two groups, except for a significantly higher incidence of diabetic patients in Israel who were randomized to CABG, compared to those worldwide (35% vs. 16%, P = 0.01). Also, there were more patients with unstable angina in Israel (63 vs. 37%, P = 0.006). At 1 year follow-up, overall mortality and cerebrovascular accident rates were similar between the two groups and equivalent to results obtained around the world. There was a significantly higher incidence of myocardial infarction rates in patients randomized to stenting in Israel compared to patients worldwide (7.4 vs. 5.3%, P = 0.01) or to patients randomized to CABG in Israel (7.4 vs. 0%, P = 0.006). Similar to the overall ARTS results, there was a higher incidence of repeat revascularization procedures in patients assigned to the PCI with stenting arm (22.2 vs. 3.8%, P = 0.004) compared to those randomized to CABG, respectively.


CONCLUSIONS
The results of this analysis of the Israeli ARTS population indicate that coronary stenting and bypass surgery yield similar findings with regard to mortality and stroke and are comparable to those obtained in the whole study group. Likewise, coronary stenting was associated with an increased incidence of repeat revascularization procedures as compared to CABG. However, patients in Israel randomized to stenting had a higher rate of myocardial infarction as compared to the overall results and to patients who underwent CABG in Israel. The present analysis provides important data for the safety and efficacy of either stenting or bypass surgery in treating patients with multivessel disease in Israel.
Gruberg
Luis
L
Division of Invasive Cardiology, Dept. of Cardiology, Rambam Medical Center, Haifa 31096, Israel. gruberg67@hotmail.com
Milo
Simcha
S
Ben Tzvi
Margalit
M
Lotan
Chaim
C
Merin
Gideon
G
Braun
Shimon
S
Mohr
Rephael
R
Tzivoni
Dan
D
Bitran
Dan
D
Beyar
Rafael
R
D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D015607:Stents; D020521:Stroke / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome