title: Multivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial.
abstract: OBJECTIVE
  The purpose of this study was to assess the 3-year outcome of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SES) in patients who had multivessel coronary artery disease with and without diabetes mellitus.
  
  
  BACKGROUND
  The optimal method of revascularization in diabetic patients remains in dispute.
  
  
  METHODS
  The ARTS-II (Arterial Revascularization Therapies Study-Part II) trial is a single-arm study (n = 607) that included 159 diabetic patients treated with SES whose 3-year clinical outcome was compared with that of the historical diabetic and nondiabetic arms of the randomized ARTS-I trial (n = 1,205, including 96 diabetic patients in the CABG arm and 112 in the PCI arm).
  
  
  RESULTS
  At 3 years, among nondiabetic patients, the incidence of the primary composite of death, CVA, myocardial infarction (MI), and repeat revascularization (major adverse cardiac and cerebrovascular events [MACCE]), was significantly lower in ARTS-II than in ARTS-I PCI (adjusted odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.26 to 0.64) and similar to ARTS-I CABG. The ARTS-II patients were at significantly lower risk for death, CVA, and MI as compared with both the ARTS-I PCI (adjusted OR: 0.55; 95% CI: 0.34 to 0.91) and ARTS-I CABG patients (adjusted OR: 0.56; 95% CI: 0.35 to 0.92). Among diabetic patients, the incidence of MACCE in ARTS-II was similar to that of both PCI and CABG in ARTS-I. Conversely, the incidence of death, CVA, and MI was significantly lower in ARTS-II than in ARTS-I PCI (adjusted OR: 0.67; 95% CI: 0.27 to 1.65) and was similar to that of ARTS-I CABG.
  
  
  CONCLUSIONS
  At 3 years, PCI using SES for patients with multivessel coronary artery disease seems to be safer and more efficacious than PCI using bare-metal stents, irrespective of the diabetic status of the patient. Hence, PCI using SES appears to be a valuable alternative to CABG for both diabetic and nondiabetic patients.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Daemen
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Victor
authors.initials: V
authors.lastname: LeGrand
authors.forename: Maarten
authors.initials: M
authors.lastname: Vrolix
authors.forename: Didier
authors.initials: D
authors.lastname: Carrie
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Maarten Jan
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Pascal
authors.initials: P
authors.lastname: Vranckx
authors.forename: Tessa
authors.initials: T
authors.lastname: Rademaker
authors.forename: Dick
authors.initials: D
authors.lastname: Goedhart
authors.forename: Monique
authors.initials: M
authors.lastname: Schuijer
authors.forename: Kristel
authors.initials: K
authors.lastname: Wittebols
authors.forename: Nathalie
authors.initials: N
authors.lastname: Macours
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Stoll
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D016001:Confidence Intervals; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D048909:Diabetes Complications / Q000628:therapy*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D009204:Myocardial Revascularization / Q000379:methods*; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus