Arterial%20Revascularization%20Therapies%20Part%20II:%20a%20non-randomized%20comparison%20of%20contemporary%20PCI%20and%20coronary%20artery%20bypass%20grafting%20(CABG)%20in%20patients%20with%20multi-vessel%20coronary%20artery%20lesions - PowerPoint PPT Presentation

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Arterial%20Revascularization%20Therapies%20Part%20II:%20a%20non-randomized%20comparison%20of%20contemporary%20PCI%20and%20coronary%20artery%20bypass%20grafting%20(CABG)%20in%20patients%20with%20multi-vessel%20coronary%20artery%20lesions

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Clinical trial results.org. Sirolimus-eluting stent. 3.7 stents per patient ... Clinical trial results.org. ARTS II: MACCE at one year. TCT 2004. Overall MACCE ... – PowerPoint PPT presentation

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Title: Arterial%20Revascularization%20Therapies%20Part%20II:%20a%20non-randomized%20comparison%20of%20contemporary%20PCI%20and%20coronary%20artery%20bypass%20grafting%20(CABG)%20in%20patients%20with%20multi-vessel%20coronary%20artery%20lesions


1
Arterial Revascularization Therapies Part II a
non-randomized comparison of contemporary PCI and
coronary artery bypass grafting (CABG) in
patients with multi-vessel coronary artery lesions
ARTS-II Trial
Presented at The American College of Cardiology
2005
2
ARTS-II Trial
Historical Controls from ARTS I 1202 patients
with multivessel coronary lesions 18.2
diabetic 28 3 vessel disease 7.5 type C lesions
607 patients with multivessel coronary
lesions 26.2 diabetic 54 3 vessel disease 13.9
type C lesions
Bare Metal Stent 2.8 stents per patient Avg total
length 48 mm n 600
Sirolimus-eluting stent 3.7 stents per
patient Avg total length 73 mm n 607
CABG n 602
  • Endpoints
  • Primary Major adverse cardiac and
    cerebrovascular events (MACCE), including
    death, cerebrovascular event, myocardial
    infarction, and revascularization, at 1 year
    for the comparison of CABG treated patients in
    the ARTS I trial with sirolimus-eluting stent
    patients in the ARTS II trial
  • Secondary MACCE at 30 days, 6 months, 3 and 5
    years.
  • Total cost at 30 days
  • Cost, cost effectiveness, quality of life at
    six mo, and 1, 3, and 5 years

ACC 2005
3
ARTS II Event free survival
At one year, there was no difference in
event-free survival between the ARTS II SES group
and the ARTS I CABG group. However, the ARTS II
group showed significantly higher rates of
survival free from cardiac death, MI, and
reintervention than the ARTS I bare metal stent
group. The groups were not significantly
different in the primary endpoint of survival
free from MACCE.
p lt0.001
p 0.003
p 0.46



ACC 2005
4
ARTS II MACCE at one year
Overall MACCE at 1 year
  • At 1 year, there was no difference in the
    incidence of MACCE between the ARTS II SES group
    and the ARTS I CABG group.
  • The ARTS I bare metal stent group was
    associated with a significantly higher rate of 1
    year MACCE compared to the other groups

TCT 2004
ACC 2005
5
ARTS II components of MACCE
At one year, there was no difference in any
components of MACCE, including death,
cerebrovascular events (CVE), MI, or
revascularization with CABG or PCI between the
ARTS II SES group and ARTS I CABG patients. The
ARTS I bare metal stent group was associated with
a significantly higher rate of revascularization
with PCI compared to the ARTS II SES group.
pNS
pNS
pNS
pNS

ACC 2005
6
ARTS II Summary
  • Among patients with multivessel coronary
    lesions, patients treated with sirolimus-eluting
    stents had significantly lower rates of MACCE
    compared with a historical registry of similar
    patients treated with bare metal stents and rates
    of MACCE statistically equivalent to patients
    from the same registry treated with CABG.
  • The majority of the difference in MACCE between
    the ARTS II and ARTS I BMS groups was driven by
    the increased need for repeat revascularization
    in the bare metal stent group. The ARTS II group
    had equal rates of revascularization to the ARTS
    I CABG group, despite having increased length
    and complexity of lesions.
  • While this historical registry comparison is
    promising and statistical measures were used to
    adjust for co-founding variables, a randomized
    trial is needed to adequately determine the
    superiority of one therapy over another.

ACC 2005
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