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.
OBJECTIVE
To compare coronary stent implantation and bypass surgery for multivessel coronary disease in patients with renal insufficiency.


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).


CONCLUSIONS
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.
Aoki
Jiro
J
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Ong
Andrew T L
AT
Hoye
Angela
A
van Herwerden
Lex A
LA
Sousa
J Eduardo
JE
Jatene
Adib
A
Bonnier
Johannes J R M
JJ
Schönberger
Jacques P M A
JP
Buller
Nigel
N
Bonser
Robert
R
Lindeboom
Wietze
W
Unger
Felix
F
Serruys
Patrick W
PW
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome