title: Impact of stable versus unstable coronary artery disease on 1-year outcome in elective patients undergoing multivessel revascularization with sirolimus-eluting stents: a subanalysis of the ARTS II trial.
abstract: OBJECTIVE
  We sought to evaluate the impact of unstable coronary artery disease (CAD) on short- and mid-term outcomes in patients with multivessel disease treated by multiple sirolimus-eluting stents (SES) as part of ARTS II (Arterial Revascularization Therapies Study Part II).
  
  
  BACKGROUND
  The differential safety/efficacy profile of SES when implanted in patients with unstable angina (UA) in comparison with stable angina (SA) undergoing multivessel intervention is largely unknown.
  
  
  METHODS
  Between February 2003 and November 2003, 607 patients at 45 participating centers were treated; 221 of them (36%) presented with UA.
  
  
  RESULTS
  At 30 days, the cumulative rate of death, myocardial infarction-defined as any creatine kinase (CK)/CK-myocardial band elevation beyond the upper limit of normal-cerebrovascular accident, and repeat revascularization (i.e., major adverse cardiac and cerebrovascular events [MACCEs]) was 19.9% in both groups. Angiographic subacute stent occlusion was documented in 1 (0.5%) and 4 (1%) patients in the UA and SA groups, respectively. At 1 year, the cumulative incidence of MACCEs was 27.1% in the UA and 24.9% in the SA group (p = 0.56). Two late occlusions occurred, both in the SA group. After adjustment for baseline and procedural characteristics, the presence of UA was not identified as an independent predictor of MACCE (hazard ratio 0.94; 95% confidence interval 0.41 to 2.12; p = 0.88). These findings remained consistent after increasing the CK/CK-myocardial band threshold to define periprocedural myocardial infarction up to at least 3 or 5 times the upper limit of normal.
  
  
  CONCLUSIONS
  In ARTS II, an unstable clinical presentation did not exert a negative impact on short- and mid-term outcome after SES implantation for multivessel disease. (ARTS II Trial; ; NCT00235170).
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Keith
authors.initials: K
authors.lastname: Dawkins
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Bernard
authors.initials: B
authors.lastname: de Bruyne
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.forename: Richardt
authors.initials: R
authors.lastname: Gert
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Angelo
authors.initials: A
authors.lastname: Ramondo
authors.forename: Kristel
authors.initials: K
authors.lastname: Wittebols
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Stoll
authors.forename: Tessa A M
authors.initials: TA
authors.lastname: Rademaker
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000188:drug therapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009204:Myocardial Revascularization / Q000379:methods*; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020123:Sirolimus