Comparison of bypass surgery and stenting for the treatment of multivessel disease: Results from the ARTS Trial in Israel

Luis Gruberg, Simcha Milo, Margalit Ben Tzvi, Chaim Lotan, Gideon Merin, Shimon Braun, Rephael Mohr, Dan Tzivoni, Dan Bitran, Rafael Beyar

Research output: Contribution to journalArticle

Abstract

Background: The Arterial Revascularization Therapies Study was a multicenter, randomized trial designed to compare percutaneous coronary intervention with stenting versus coronary artery bypass graft surgery in 1,205 patients with multivessel coronary artery disease. The most appropriate type of treatment for these patients is still a matter of considerable debate. Objectives: To evaluate the clinical characteristics of patients enrolled in the ARTS trial in Israel in comparison to those worldwide, and to assess the 1 year outcome in these patients. Methods: Between April 1997 and June 1998, a total of 1,205 patients with multivessel coronary artery disease, who were considered to be equally treatable with both modalities, were randomized to either stenting (n=600) or CABG (n=605) at 67 centers around the world. In Israel, 53 patients at four participating medical centers were randomized to either PCI with stents (n=27) or CABG (n=26). Results: Clinical and angiographic characteristics were similar in the two groups, except for a significantly higher incidence of diabetic patients in Israel who were randomized to CABG, compared to those worldwide (35% vs. 16%, P = 0.01). Also, there were more patients with unstable angina in Israel (63 vs. 37%, P = 0.006). At 1 year follow-up, overall mortality and cerebrovascular accident rates were similar between the two groups and equivalent to results obtained around the world. There was a significantly higher incidence of myocardial infarction rates in patients randomized to stenting in Israel compared to patients worldwide (7.4 vs. 5.3%, P = 0.01) or to patients randomized to CABG in Israel (7.4 vs. 0%, P = 0.006). Similar to the overall ARTS results, there was a higher incidence of repeat revascularization procedures in patients assigned to the PCI with stenting arm (22.2 vs. 3.8%, P = 0.004) compared to those randomized to CABG, respectively. Conclusions: The results of this analysis of the Israeli ARTS population indicate that coronary stenting and bypass surgery yield similar findings with regard to mortality and stroke and are comparable to those obtained in the whole study group. Likewise, coronary stenting was associated with an increased incidence of repeat revascularization procedures as compared to CABG. However, patients in Israel randomized to stenting had a higher rate of myocardial infarction as compared to the overall results and to patients who underwent CABG in Israel. The present analysis provides important data for the safety and efficacy of either stenting or bypass surgery in treating patients with multivessel disease in Israel.

Original languageEnglish (US)
Pages (from-to)539-542
Number of pages4
JournalThe Israel Medical Association journal : IMAJ
Volume5
Issue number8
StatePublished - Aug 1 2003
Externally publishedYes

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Israel
Surgery
Stents
Grafts
Accidents
Therapeutics
Incidence
Coronary Artery Disease
Stroke
Myocardial Infarction
Mortality
Unstable Angina
Percutaneous Coronary Intervention
Coronary Artery Bypass
Multicenter Studies

Keywords

  • Angioplasty
  • Bypass surgery
  • Coronary
  • Stents

ASJC Scopus subject areas

  • Medicine(all)
  • Bioengineering

Cite this

Comparison of bypass surgery and stenting for the treatment of multivessel disease : Results from the ARTS Trial in Israel. / Gruberg, Luis; Milo, Simcha; Tzvi, Margalit Ben; Lotan, Chaim; Merin, Gideon; Braun, Shimon; Mohr, Rephael; Tzivoni, Dan; Bitran, Dan; Beyar, Rafael.

In: The Israel Medical Association journal : IMAJ, Vol. 5, No. 8, 01.08.2003, p. 539-542.

Research output: Contribution to journalArticle

Gruberg, L, Milo, S, Tzvi, MB, Lotan, C, Merin, G, Braun, S, Mohr, R, Tzivoni, D, Bitran, D & Beyar, R 2003, 'Comparison of bypass surgery and stenting for the treatment of multivessel disease: Results from the ARTS Trial in Israel', The Israel Medical Association journal : IMAJ, vol. 5, no. 8, pp. 539-542.
Gruberg, Luis ; Milo, Simcha ; Tzvi, Margalit Ben ; Lotan, Chaim ; Merin, Gideon ; Braun, Shimon ; Mohr, Rephael ; Tzivoni, Dan ; Bitran, Dan ; Beyar, Rafael. / Comparison of bypass surgery and stenting for the treatment of multivessel disease : Results from the ARTS Trial in Israel. In: The Israel Medical Association journal : IMAJ. 2003 ; Vol. 5, No. 8. pp. 539-542.
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abstract = "Background: The Arterial Revascularization Therapies Study was a multicenter, randomized trial designed to compare percutaneous coronary intervention with stenting versus coronary artery bypass graft surgery in 1,205 patients with multivessel coronary artery disease. The most appropriate type of treatment for these patients is still a matter of considerable debate. Objectives: To evaluate the clinical characteristics of patients enrolled in the ARTS trial in Israel in comparison to those worldwide, and to assess the 1 year outcome in these patients. Methods: Between April 1997 and June 1998, a total of 1,205 patients with multivessel coronary artery disease, who were considered to be equally treatable with both modalities, were randomized to either stenting (n=600) or CABG (n=605) at 67 centers around the world. In Israel, 53 patients at four participating medical centers were randomized to either PCI with stents (n=27) or CABG (n=26). Results: Clinical and angiographic characteristics were similar in the two groups, except for a significantly higher incidence of diabetic patients in Israel who were randomized to CABG, compared to those worldwide (35{\%} vs. 16{\%}, P = 0.01). Also, there were more patients with unstable angina in Israel (63 vs. 37{\%}, P = 0.006). At 1 year follow-up, overall mortality and cerebrovascular accident rates were similar between the two groups and equivalent to results obtained around the world. There was a significantly higher incidence of myocardial infarction rates in patients randomized to stenting in Israel compared to patients worldwide (7.4 vs. 5.3{\%}, P = 0.01) or to patients randomized to CABG in Israel (7.4 vs. 0{\%}, P = 0.006). Similar to the overall ARTS results, there was a higher incidence of repeat revascularization procedures in patients assigned to the PCI with stenting arm (22.2 vs. 3.8{\%}, P = 0.004) compared to those randomized to CABG, respectively. Conclusions: The results of this analysis of the Israeli ARTS population indicate that coronary stenting and bypass surgery yield similar findings with regard to mortality and stroke and are comparable to those obtained in the whole study group. Likewise, coronary stenting was associated with an increased incidence of repeat revascularization procedures as compared to CABG. However, patients in Israel randomized to stenting had a higher rate of myocardial infarction as compared to the overall results and to patients who underwent CABG in Israel. The present analysis provides important data for the safety and efficacy of either stenting or bypass surgery in treating patients with multivessel disease in Israel.",
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T2 - Results from the ARTS Trial in Israel

AU - Gruberg, Luis

AU - Milo, Simcha

AU - Tzvi, Margalit Ben

AU - Lotan, Chaim

AU - Merin, Gideon

AU - Braun, Shimon

AU - Mohr, Rephael

AU - Tzivoni, Dan

AU - Bitran, Dan

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N2 - Background: The Arterial Revascularization Therapies Study was a multicenter, randomized trial designed to compare percutaneous coronary intervention with stenting versus coronary artery bypass graft surgery in 1,205 patients with multivessel coronary artery disease. The most appropriate type of treatment for these patients is still a matter of considerable debate. Objectives: To evaluate the clinical characteristics of patients enrolled in the ARTS trial in Israel in comparison to those worldwide, and to assess the 1 year outcome in these patients. Methods: Between April 1997 and June 1998, a total of 1,205 patients with multivessel coronary artery disease, who were considered to be equally treatable with both modalities, were randomized to either stenting (n=600) or CABG (n=605) at 67 centers around the world. In Israel, 53 patients at four participating medical centers were randomized to either PCI with stents (n=27) or CABG (n=26). Results: Clinical and angiographic characteristics were similar in the two groups, except for a significantly higher incidence of diabetic patients in Israel who were randomized to CABG, compared to those worldwide (35% vs. 16%, P = 0.01). Also, there were more patients with unstable angina in Israel (63 vs. 37%, P = 0.006). At 1 year follow-up, overall mortality and cerebrovascular accident rates were similar between the two groups and equivalent to results obtained around the world. There was a significantly higher incidence of myocardial infarction rates in patients randomized to stenting in Israel compared to patients worldwide (7.4 vs. 5.3%, P = 0.01) or to patients randomized to CABG in Israel (7.4 vs. 0%, P = 0.006). Similar to the overall ARTS results, there was a higher incidence of repeat revascularization procedures in patients assigned to the PCI with stenting arm (22.2 vs. 3.8%, P = 0.004) compared to those randomized to CABG, respectively. Conclusions: The results of this analysis of the Israeli ARTS population indicate that coronary stenting and bypass surgery yield similar findings with regard to mortality and stroke and are comparable to those obtained in the whole study group. Likewise, coronary stenting was associated with an increased incidence of repeat revascularization procedures as compared to CABG. However, patients in Israel randomized to stenting had a higher rate of myocardial infarction as compared to the overall results and to patients who underwent CABG in Israel. The present analysis provides important data for the safety and efficacy of either stenting or bypass surgery in treating patients with multivessel disease in Israel.

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KW - Angioplasty

KW - Bypass surgery

KW - Coronary

KW - Stents

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