Document Detail


Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART).
MedLine Citation:
PMID:  20805116     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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).
Authors:
David P Taggart; Douglas G Altman; Alastair M Gray; Belinda Lees; Fiona Nugara; Ly-Mee Yu; Helen Campbell; Marcus Flather;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-08-30
Journal Detail:
Title:  European heart journal     Volume:  31     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-15     Completed Date:  2011-09-30     Revised Date:  2014-03-17    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2470-81     Citation Subset:  IM    
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN46552265
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MeSH Terms
Descriptor/Qualifier:
Female
Humans
Internal Mammary-Coronary Artery Anastomosis / methods*,  mortality
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Ischemia / mortality,  surgery*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
10859//Cancer Research UK; G0200390//Medical Research Council; SP/03/001//British Heart Foundation
Investigator
Investigator/Affiliation:
D Taggart / ; C Ratnatunga / ; S Westaby / ; S Wos / ; M Jasinski / ; K Widenka / ; A Blach / ; R Gocol / ; D Hudziak / ; P Zurek / ; M Deja / ; R Bachowski / ; R Mrozek / ; T Kargul / ; W Domarardzki / ; V Zamvar / ; B Buxton / ; S Seevanayagam / ; G Matalanis / ; A Rosalion / ; J Negri / ; S Moten / ; V Atkinson / ; A Newcomb / ; P O'Keefe / ; U von Oppell / ; D Mehta / ; A Azzu / ; A Szafranek / ; E Kulatilake / ; U Trivedi / ; A Forsyth / ; J Hyde / ; A Cohen / ; M Lewis / ; S Clark / ; J Dark / ; K Tocewicz / ; T Pillay / ; A Bochenek / ; M Cisowski / ; M Bolkowski / ; W Morawski / ; M Guc / ; M Krejca / ; M Wilczynski / ; A Duralek / ; W Gerber / ; J Skarysz / ; R Shrestha / ; W Swiech / ; P Szmagala / ; R Hasan / ; D Keenan / ; B Prendergast / ; N Odom / ; K McLaughlin / ; J Desai / ; A El-Gamel / ; L John / ; O Wendler / ; A Ritchie / ; C Choong / ; S Nair / ; D Jenkins / ; S Large / ; C Sudarshan / ; M Barman / ; K Dhital / ; T Routledge / ; B Rosengard / ; A Cale / ; S Griffin / ; T Spyt / ; M Hickey / ; A Sosnowski / ; G Peek / ; J Szostek / ; L Hadjinikalaou / ; J Gaer / ; M Amrani / ; G Dreyfus / ; T Bahrami / ; F de Robertis / ; K Baig / ; G Asimakopoulos / ; H Vohra / ; V Pai / ; S Tadjkarimi / ; B Soleimani / ; G Stavri / ; J Sadowksi / ; B Gaweda / ; P Rudzinski / ; J Stolinski / ; F Moraes / ; C Moraes / ; J Pepper / ; A De Souza / ; M Petrou / ; R Trimlett / ; V Chandrasekaran / ; R Kanagasaby / ; M Sarsam / ; R Pawlaczyk / ; P Siondalski / ; J Rogowski / ; K Roszak / ; K Jarmoszewicz / ; D Jagielak / ; G Mannam / ; G Naguboyin / ; L Rao Sajja / ; B Dandu / ; N Briffa / ; P Braidley / ; G Cooper / ; R Casabona / ; G Actis Dato / ; G Bardi / ; S Del Ponte / ; P Forsennati / ; F Parisi / ; G Punta / ; W Dihmis / ; M Kuduvali / ; L Anisimowicz / ; M Bokszanski / ; W Pawliszak / ; J Kolakowski / ; G Lau / ; W Ogorzeja / ; B Podesser / ; K Trescher / ; O Bernecker / ; Ch Holzinger / ; K Binder / ; I Schor / ; P Bergmann / ; H Kassal / ; N Trehan / ; Z Meharwal / ; R Malhotra / ; M Goel / ; B Kumer / ; S Bazaz / ; N Bake / ; A Singh / ; Y Mishka / ; R Gupta / ; M Zembala / ; B Szafron / ; J Pacholewicz / ; M Krason / ; Wojarski / ; Zych / ; K Widenka / ; I Szymanik / ; M Kolwca / ; W Mazur / ; A Kurowicki / ; S Zurek / ; T Stacel / ; J Cook / ; C Wallis / ; J Frackiewicz / ; D Ezakadan / ; P Polidano / ; R Pana / ; S Gerbo / ; J Evans / ; N Martin / ; D Banner / ; E Gardner / ; A MacKenzie / ; N Cooter / ; E Joyce / ; S Rowling / ; L Krzych / ; A Pawlak / ; G Cummings-Fosong / ; C Mathew / ; H Iles-Smith / ; M Andrews / ; K Rance / ; R Williams / ; V Hogervorst / ; J Gregory / ; H Munday / ; K Rintoul / ; E Jarrett / ; S Lao-Sirieix / ; A Wilkinson / ; J Dickson / ; E Logtens / ; M Oakley / ; G Bull / ; H Collappen / ; J Wanderley / ; T Morgan / ; J Gavino / ; H Ryan / ; L Billings / ; L Ruddick / ; A Achampong / ; S Gafka / ; A Knighton / ; K Allen / ; R Flocco / ; F Sansone / ; E Zingarelli / ; C Prince / ; H Rogers / ; I Gumanska / ; P Kulinski / ; B Motovova / ; S Basumatary / ; I Jaworska / ; G Vermes / ; D Altman / ; J Dark / ; B Farrell / ; M Flather / ; A Gray / ; J Pepper / ; P Sleight / ; K Channon / ; R Stables / ; D Taggart / ; J Pearson / ; M Pitman / ; S Yusuf / ; S Pocock / ; D Julian / ; T Treasure / ; U Trivedi / ; P O'Keefe / ; U Von Oppel / ; V Zamvar / ; A Cale / ; M Hickey / ; T Spyt / ; J Pepper / ; R Kanagasabay / ; T Pillay / ; P Braidley / ; G Cooper / ; M Flather / ; J Collinson / ; A Bakhai / ; R Pawlaczyk / ; R O'Hanlon / ; D Kotecha / ; K Qureshi / ; L Krzych / ; T Geisler / ; N Briffa / ; L Manzano-Espinosa / ; M Jasinski /
Comments/Corrections
Comment In:
Eur Heart J. 2010 Oct;31(20):2444-6   [PMID:  20852294 ]

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