title: Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial.
abstract: OBJECTIVE
  The long-term (five-year) comparative results of treatment of multivessel coronary artery disease with stenting or coronary artery bypass grafting (CABG) is at present unknown.
  
  
  BACKGROUND
  The Arterial Revascularization Therapies Study (ARTS) was designed to compare CABG and stenting in patients with multivessel disease.
  
  
  METHODS
  A total of 1,205 patients with the potential for equivalent revascularization were randomly assigned to CABG (n = 605) or stent implantation (n = 600). The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events (MACCE) at one year; MACCE at five-year follow-up constituted the final secondary end point.
  
  
  RESULTS
  At five years, there were 48 and 46 deaths in the stent and CABG groups, respectively (8.0% vs. 7.6%; p = 0.83; relative risk [RR], 1.05; 95% confidence interval [CI], 0.71 to 1.55). Among 208 diabetic patients, mortality was 13.4% in the stent group and 8.3% in the CABG group (p = 0.27; RR, 1.61; 95% CI, 0.71 to 3.63). Overall freedom from death, stroke, or myocardial infarction was not significantly different between groups (18.2% in the stent group vs. 14.9% in the surgical group; p = 0.14; RR, 1.22; 95% CI, 0.95 to 1.58). The incidence of repeat revascularization was significantly higher in the stent group (30.3%) than in the CABG group (8.8%; p < 0.001; RR, 3.46; 95% CI, 2.61 to 4.60). The composite event-free survival rate was 58.3% in the stent group and 78.2% in the CABG group (p < 0.0001; RR, 1.91; 95% CI, 1.60 to 2.28).
  
  
  CONCLUSIONS
  At five years there was no difference in mortality between stenting and surgery for multivessel disease. Furthermore, the incidence of stroke or myocardial infarction was not significantly different between the two groups. However, overall MACCE was higher in the stent group, driven by the increased need for repeat revascularization.
authors.affiliation: Interventional Cardiology Department, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. p.w.j.c.serruys@erasmusmc.nl
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Andrew T L
authors.initials: AT
authors.lastname: Ong
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: Clemens
authors.initials: C
authors.lastname: Disco
authors.forename: Bianca
authors.initials: B
authors.lastname: Backx
authors.forename: Paul G
authors.initials: PG
authors.lastname: Hugenholtz
authors.forename: Brian G
authors.initials: BG
authors.lastname: Firth
authors.forename: Felix
authors.initials: F
authors.lastname: Unger
mesh_terms: D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome