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
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
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DOI：
10.1016/j.jacc.2004.12.082
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发表时间：
2005-08-16
影响因子：
24
通讯作者：
Unger, F
中科院分区：
文献类型：
--
作者：
Serruys, PW;Ong, ATL;Unger, F
长期采用支架术或冠状动脉旁路移植术（CABG）治疗多支冠状动脉疾病的5年比较结果目前尚不清楚。将205例具有等效血运重建潜力的患者随机分配至CABG组（n = 605）或支架植入组（n = 600）。主要临床终点是1年时无主要不良心脑血管事件（MACCE）; 5年随访时的MACCE构成最终的次要终点。结果5年时，支架组和CABG组分别有48例和46例死亡（8.0% vs. 7.6%; p = 0.83;相对风险[RR]，1.05; 95%置信区间[CI]，0.71 - 1.55）。在208例糖尿病患者中，支架组和CABG组的死亡率分别为13.4%和8.3%（p = 0.27; RR，1.61; 95% CI，0.71 - 3.63）。两组之间的总体无死亡、卒中或心肌梗死率无显著差异（支架组为18.2%，手术组为14.9%; p = 0.14; RR，1.22; 95% CI，0.95 - 1.58）。支架组的再次血运重建发生率（30.3%）显著高于CABG组（8.8%; p < 0.001; RR，3.46;95% CI，2.61 - 4.60）。支架组和CABG组的复合无事件生存率分别为58.3%和78.2%（p < 0.0001; RR，1.91; 95%CI，1.60 - 2.28）。此外，两组之间卒中或心肌梗死的发生率无显著差异。然而，支架组的总体MACCE较高，这是由于重复血运重建的需求增加。(c)2005年美国心脏病学会基金会
OBJECTIVES 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. (c) 2005 by the American College of Cardiology Foundation