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CABG more durable than PCI with sirolimus-eluting stents for multivessel disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In patients with complex multivessel coronary disease, long-term revascularization rates are lower after surgery than after percutaneous coronary intervention (PCI) with sirolimus-eluting stents, according to 5-year data from the ARTS (Arterial Revascularization Therapies) studies I and II.

In other respects, however, PCI with sirolimus-eluting stents was as safe as surgery, with similar rates of mortality, stroke and myocardial infarction, the researchers report online February 17 in the Journal of the American College of Cardiology.

Lead author Dr. Patrick W. Serruys from Erasmus Medical Center in Rotterdam, The Netherlands, and his colleagues explain that ARTS II was a multicenter, nonrandomized, open-label trial of sirolimus-eluting stents in patients with de novo multivessel coronary artery disease. ARTS I – conducted in a similar population — was an earlier randomized trial that compared coronary artery bypass grafting (CABG) to PCI with bare metal stents.

The more recent ARTS II (February to November, 2003) involved 607 patients. ARTS I, conducted in 1997-1911197, included 602 patients in the CABG group and 600 in the bare metal stent group.

The mean number of significant lesions per patient was 3.6 in ARTS II and 2.8 in each arm of ARTS I.

Survival did not differ significantly among the three groups (ARTS II, 94.5%; CABG, 92.6%; bare metal stents, 92.0%), nor did rates of the composite end point of survival free of stroke and myocardial infarction (87.1%, 86.0% and 81.9%, respectively).

Survival free of major adverse cardiac and cerebrovascular events (all-cause death, stroke, nonfatal myocardial infarction, or any repeat revascularization) was 79.0% with CABG, 72.5% with sirolimus-eluting stents (p=0.02), and 58.5% with bare metal stents (p = 0.001). At 3 years, rates of this composite end point had been similar with sirolimus-eluting stents and CABG, the authors note.

They also point out that the difference in major adverse cardiac and cerebrovascular events was driven primarily by relatively higher rate of reintervention in the sirolimus group compared with CABG. This, they say, “confirms that surgical revascularization is more durable than percutaneous revascularization.”

They estimate that a third of adverse events might have been avoided by preventing stent thrombosis.

“These results emphasize the importance of optimal stent implantation, development of less thrombogenic devices…and in addition, more effective antithrombotic therapies,” the researchers conclude.

Drawbacks of the study included lack of randomization and time lag between enrollment periods of ARTS I and II.

J Am Coll Cardiol 2010.