title: One-year results of coronary revascularization in diabetic patients with multivessel coronary artery disease.Sirolimus stent vs. coronary artery bypass surgery and bare metal stent: insights from ARTS-II and ARTS-I.
abstract: BACKGROUND
  ARTS-II was designed to evaluate the sirolimus-eluting stent (SES) versus ARTS-I. The objective of this analysis is to assess the safety and efficacy of the SES in diabetic patients with multivessel disease (MVD) versus both arms of ARTS-I.
  
  
  RESULTS
  The ARTS studies included 367 diabetic patients (ARTS-II: 159; ARTS-I-CABG: 96; ARTS-I-PCI: 112). Baseline characteristics showed a more diseased patient population in the ARTS-II study: 50.3% with 3VD vs. 35.4% (ARTS-I-CABG) and 30.8% (ARTS-I-PCI) (p=0.003). Treated or anastomosed lesions were 3.2+/-1.2 (ARTS-II), 2.8+/-0.8 (ARTS-I-CABG) and 2.5+/-1.1 (ARTS-I-PCI). At 30 days there was a significant difference in MACCE between ARTS-II (4.4%) and ARTS-I-PCI (12.5%) (p=0.02). At 1-year, the death rate was 2.5% (ARTS-II) vs. 3.1% (ARTS-I-CABG) and 6.3% (ARTS-I-PCI) without significant differences. Myocardial infarction rate was 0.6% (ARTS-II) vs. 2.1% (ARTS-I-CABG; p=0.56) and 6.3% (ARTS-I-PCI; p=0.01). The need for repeat revascularization was 12.6% (ARTS-II) vs. 4.2% (ARTS-I-CABG; p=0.027) and 22.3% (ARTS-I-PCI; p= 0.046). MACCE-free survival was 84.3% (ARTS-II) vs. 85.4% (ARTS-I-CABG; p=0.86) and 63.4% (ARTS-I-PCI; p<0.001). Also at 1 year, the overall MACCE rate in patients with diabetes was significantly higher than in nondiabetic patients, 15.7% vs. 8.5%, respectively [RR 1.85, 95%CI (1.16,2.97), p=0.015), due to a higher incidence of death and need for repeat revascularization, 2.5% vs. 0.4 and 12.5% vs. 5.6% in diabetes vs. nondiabetes groups, respectively.
  
  
  CONCLUSIONS
  Despite more extensive and treated disease, the overall MACCE-free survival in diabetic patients at 1 year in ARTS-II is similar to ARTS-I-CABG.
authors.affiliation: Hospital Clinico St. Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Héctor M
authors.initials: HM
authors.lastname: García-García
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Victor
authors.initials: V
authors.lastname: Legrand
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Maarten Jan
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Didier
authors.initials: D
authors.lastname: Carrie
authors.forename: Mathias
authors.initials: M
authors.lastname: Vrolix
authors.forename: Kristel
authors.initials: K
authors.lastname: Wittebols
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Stoll
authors.forename: Dennis
authors.initials: D
authors.lastname: Donohoe
authors.forename: Marco
authors.initials: M
authors.lastname: Bressers
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys