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.
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.
Daemen
Joost
J
Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
Kuck
Karl Heinz
KH
Macaya
Carlos
C
LeGrand
Victor
V
Vrolix
Maarten
M
Carrie
Didier
D
Sheiban
Imad
I
Suttorp
Maarten Jan
MJ
Vranckx
Pascal
P
Rademaker
Tessa
T
Goedhart
Dick
D
Schuijer
Monique
M
Wittebols
Kristel
K
Macours
Nathalie
N
Stoll
Hans Peter
HP
Serruys
Patrick W
PW
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
D007166:Immunosuppressive Agents; D020123:Sirolimus