Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART).
AIMS: Observational data suggest that the use of bilateral internal mammary arteries (BIMA) during coronary artery bypass graft surgery provides superior revascularization to a single internal mammary artery (SIMA), but concerns about safety have prevented the widespread use of BIMA. The Arterial Re...
| Principais autores: | , , , , , , , |
|---|---|
| Formato: | Journal article |
| Idioma: | English |
| Publicado em: |
2010
|
| _version_ | 1826274988181684224 |
|---|---|
| author | Taggart, D Altman, D Gray, A Lees, B Nugara, F Yu, L Campbell, H Flather, M |
| author_facet | Taggart, D Altman, D Gray, A Lees, B Nugara, F Yu, L Campbell, H Flather, M |
| author_sort | Taggart, D |
| collection | OXFORD |
| description | AIMS: Observational data suggest that the use of bilateral internal mammary arteries (BIMA) during coronary artery bypass graft surgery provides superior revascularization to a single internal mammary artery (SIMA), but concerns about safety have prevented the widespread use of BIMA. The Arterial Revascularisation Trial (ART) is a randomized trial of BIMA vs. SIMA, with a primary outcome of survival at 10 years. This paper reports mortality, morbidity, and resource use data at 1 year. METHODS AND RESULTS: Coronary artery bypass graft patients were enrolled in 28 hospitals in seven countries. Three thousand one hundred and two patients were randomly assigned to SIMA (n = 1554) or BIMA (n = 1548). The mean number of grafts was 3 for both groups. Forty per cent of the SIMA procedures and 42% of the BIMA were performed off-pump. Mortality at 30 days was 18 of 1548 (1.2%) for SIMA and 19 of 1537 (1.2%) for BIMA, and at 1 year was 36 of 1540 (2.3%) and 38 of 1529 (2.5%), respectively. The rates of stroke, myocardial infarction, and repeat revascularization were all ≤2% at 1 year and similar between the two groups. Sternal wound reconstruction was required in 0.6 and 1.9% of the SIMA and BIMA groups, respectively. CONCLUSION: Data from ART demonstrate similar clinical outcomes for SIMA and BIMA at 1 year but BIMA grafts are associated with a small absolute increase (1.3%) in the need for sternal wound reconstruction. The results suggest that the use of BIMA grafts is feasible on a routine basis. The 10-year results of the ART will confirm whether BIMA grafting results in lower mortality and the need for repeat intervention. TRIAL REGISTRATION: Controlled-trials.com (ISRCTN46552265). |
| first_indexed | 2024-03-06T22:51:51Z |
| format | Journal article |
| id | oxford-uuid:5f0fdd2c-10fe-4c86-b94b-eb3721f3cf10 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:51:51Z |
| publishDate | 2010 |
| record_format | dspace |
| spelling | oxford-uuid:5f0fdd2c-10fe-4c86-b94b-eb3721f3cf102022-03-26T17:44:26ZRandomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART).Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5f0fdd2c-10fe-4c86-b94b-eb3721f3cf10EnglishSymplectic Elements at Oxford2010Taggart, DAltman, DGray, ALees, BNugara, FYu, LCampbell, HFlather, MAIMS: Observational data suggest that the use of bilateral internal mammary arteries (BIMA) during coronary artery bypass graft surgery provides superior revascularization to a single internal mammary artery (SIMA), but concerns about safety have prevented the widespread use of BIMA. The Arterial Revascularisation Trial (ART) is a randomized trial of BIMA vs. SIMA, with a primary outcome of survival at 10 years. This paper reports mortality, morbidity, and resource use data at 1 year. METHODS AND RESULTS: Coronary artery bypass graft patients were enrolled in 28 hospitals in seven countries. Three thousand one hundred and two patients were randomly assigned to SIMA (n = 1554) or BIMA (n = 1548). The mean number of grafts was 3 for both groups. Forty per cent of the SIMA procedures and 42% of the BIMA were performed off-pump. Mortality at 30 days was 18 of 1548 (1.2%) for SIMA and 19 of 1537 (1.2%) for BIMA, and at 1 year was 36 of 1540 (2.3%) and 38 of 1529 (2.5%), respectively. The rates of stroke, myocardial infarction, and repeat revascularization were all ≤2% at 1 year and similar between the two groups. Sternal wound reconstruction was required in 0.6 and 1.9% of the SIMA and BIMA groups, respectively. CONCLUSION: Data from ART demonstrate similar clinical outcomes for SIMA and BIMA at 1 year but BIMA grafts are associated with a small absolute increase (1.3%) in the need for sternal wound reconstruction. The results suggest that the use of BIMA grafts is feasible on a routine basis. The 10-year results of the ART will confirm whether BIMA grafting results in lower mortality and the need for repeat intervention. TRIAL REGISTRATION: Controlled-trials.com (ISRCTN46552265). |
| spellingShingle | Taggart, D Altman, D Gray, A Lees, B Nugara, F Yu, L Campbell, H Flather, M Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). |
| title | Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). |
| title_full | Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). |
| title_fullStr | Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). |
| title_full_unstemmed | Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). |
| title_short | Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). |
| title_sort | randomized trial to compare bilateral vs single internal mammary coronary artery bypass grafting 1 year results of the arterial revascularisation trial art |
| work_keys_str_mv | AT taggartd randomizedtrialtocomparebilateralvssingleinternalmammarycoronaryarterybypassgrafting1yearresultsofthearterialrevascularisationtrialart AT altmand randomizedtrialtocomparebilateralvssingleinternalmammarycoronaryarterybypassgrafting1yearresultsofthearterialrevascularisationtrialart AT graya randomizedtrialtocomparebilateralvssingleinternalmammarycoronaryarterybypassgrafting1yearresultsofthearterialrevascularisationtrialart AT leesb randomizedtrialtocomparebilateralvssingleinternalmammarycoronaryarterybypassgrafting1yearresultsofthearterialrevascularisationtrialart AT nugaraf randomizedtrialtocomparebilateralvssingleinternalmammarycoronaryarterybypassgrafting1yearresultsofthearterialrevascularisationtrialart AT yul randomizedtrialtocomparebilateralvssingleinternalmammarycoronaryarterybypassgrafting1yearresultsofthearterialrevascularisationtrialart AT campbellh randomizedtrialtocomparebilateralvssingleinternalmammarycoronaryarterybypassgrafting1yearresultsofthearterialrevascularisationtrialart AT flatherm randomizedtrialtocomparebilateralvssingleinternalmammarycoronaryarterybypassgrafting1yearresultsofthearterialrevascularisationtrialart |