title: 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.
abstract: 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.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jiro
authors.initials: J
authors.lastname: Aoki
authors.forename: Andrew T L
authors.initials: AT
authors.lastname: Ong
authors.forename: Angela
authors.initials: A
authors.lastname: Hoye
authors.forename: Lex A
authors.initials: LA
authors.lastname: van Herwerden
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Sousa
authors.forename: Adib
authors.initials: A
authors.lastname: Jatene
authors.forename: Johannes J R M
authors.initials: JJ
authors.lastname: Bonnier
authors.forename: Jacques P M A
authors.initials: JP
authors.lastname: Schönberger
authors.forename: Nigel
authors.initials: N
authors.lastname: Buller
authors.forename: Robert
authors.initials: R
authors.lastname: Bonser
authors.forename: Wietze
authors.initials: W
authors.lastname: Lindeboom
authors.forename: Felix
authors.initials: F
authors.lastname: Unger
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: 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