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| * These
news are selected from 'TCT Daily (2004)' provided
by Cardiovascular Research Foundation (CRF). |
Results of the Arterial Revascularization
Therapies Study II (ARTS II), presented by Patrick
Serruys, MD, of the University Hospital in Rotterdam,
the Netherlands, showed fewer adverse events, decreased
subacute thrombosis, and decreased rates of CK-MB
release than, was seen in ARTS I. ARTS I enrolled
patients with multivessel disease, comparing CABG
with multivessel stenting with regard to clinical
outcomes and cost effectiveness. ARTS II was a single-arm
trial with multivessel stenting. The ARTS II cohort
(n=607) used the ARTS I arms (n=1,205) as historical
controls
At 30 days, the rates of major adverse events were
lower in the ARTS II patients than the ARTS I CABG
and PCI patients. These outcomes were measured again
at six months with an overall rate of 6.4% in ARTS
II patients, 9% in ARTS I CABG patients, and 20%
in ARTS I PCI patients. The following individual
outcomes were also measured: death (0.5%, 1.8%,
2.3%), cerebrovascular events (0.5%, 1.2%, 1.5%),
MI (0.7%, 3.5%, 4.5%), re-CABG (1.6%, 0.5%, 3.8%),
and re-PCI (3.1%, 2.0%, 7.8%). Event-free survival
at six months was also higher among ARTS II patients
than either of the ARTS I cohorts.
ARTS II patients also had a three-fold reduction
in the number of subacute occlusions per patient
at discharge (0.5 vs. 2.5) and 30 days (0.8 vs.
2.8) compared to the stented patients in ARTS I.
ARTS I enrolled 1,205 patients with multivessel
disease and compared CABG with multivessel stenting
with regard to clinical outcomes and cost effectiveness
at 12 months. Researchers found no significant difference
in freedom from death, stroke or MI between the
two groups, although there was a 17% reduction in
revascularization in favor of surgery. In addition,
stenting proved less expensive.
In ARTS II, patients had a mean age of 62 years,
77% were men and 35% had a previous MI. Patients
in the ARTS II trial had a higher rate of diabetes,
hypertension and hypercholesterolemia than the ARTS
I patients. They also had a significantly greater
prevalence of Type C lesions and more calcification.
More lesions were stented in the ARTS II trial (3.2
+/- 1.1) than were treated in the CABG arm (2.6
+/- 1) or PCI arms (2.5 +/- 1) of the ARTS I trial.
Stents were also longer in ARTS II than the PCI
arm of ARTS I, at 73 mm and 38 mm respectively.
ARTS II patients also had a 32.5% rate of GP IIb/IIIa
inhibitor use. |
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