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Published in: Trials 1/2006

Open Access 01-12-2006 | Study protocol

Protocol for the Arterial Revascularisation Trial (ART). A randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularisation [ISRCTN46552265]

Authors: David P Taggart, Belinda Lees, Alastair Gray, Douglas G Altman, Marcus Flather, Keith Channon, the ART Investigators

Published in: Trials | Issue 1/2006

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Abstract

Background

Standard coronary artery bypass graft surgery uses a single internal mammary artery and supplemental vein or radial artery grafts. Several observational studies have suggested a survival benefit with two internal mammary artery grafts compared to a single internal mammary artery graft, but this has not been tested in a randomised trial. The Arterial Revascularisation Trial is a Medical Research Council and British Heart Foundation funded, multi-centre international trial comparing single internal mammary artery grafting versus bilateral internal mammary artery grafting.

Methods/Design

Twenty centres in the UK, Australia, Poland and Brazil are planning to randomise 3000 coronary artery bypass graft surgery patients to single or bilateral internal mammary artery grafting. Supplemental grafts may be either saphenous vein or radial artery. Coronary artery bypass grafting can be performed as an on-pump or off-pump procedure. The primary outcome is survival at 10 years and secondary end-points include clinical events, quality of life and cost effectiveness. The effect of age, left ventricular function, diabetes, number of grafts, vein grafts and off-pump surgery are pre-specified subgroups.

Discussion

The Arterial Revascularisation Trial is one of the first randomised trials to evaluate the effects on survival and other clinical outcomes of single internal mammary artery grafting versus bilateral internal mammary artery grafting, and will help to establish the best approach for patients requiring coronary artery bypass graft surgery.
Appendix
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Literature
1.
Yusuf S, Zucker D, Peduzzi P: Effect of CABG surgery on survival: overview of 10-year results from randomised trials by the CABG Trialists Collaboration. Lancet. 1994, 344: 563-570. 10.1016/S0140-6736(94)91963-1.CrossRefPubMed
2.
Keogh BE, Kinsman R: National Adult Cardiac Surgical Database Report. 1999–2001
3.
Bucher HC, Hengstler P, Schindler C: PTCA versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials. BMJ. 2001, 321: 73-7. 10.1136/bmj.321.7253.73.CrossRef
4.
Loop FD, Lytle BW, Cosgrove DM: Influence of the internal mammary artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986, 314: 1-6.CrossRefPubMed
5.
Cameron A, Davis KB, Green G: Coronary bypass surgery with internal-thoracic-artery grafts: effects on survival over a 15-year period. N Engl J Med. 1996, 334: 216-219. 10.1056/NEJM199601253340402.CrossRefPubMed
6.
Fitzgibbon GM, Kafka HB, Leach HA: Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival in reoperation in 1,388 patients during 25 years. J Am Coll Cardiol. 1996, 28: 616-626. 10.1016/0735-1097(96)00206-9.CrossRefPubMed
7.
Eagle KA, Guyton RA, Davidoff R: ACC/AHA Guidelines for CABG surgery: executive summary and recommendations. Circulation. 1999, 100: 1464-1480.CrossRefPubMed
8.
Weintraub WS, Jones EL, Craver JM, Guyton RA: Frequency of repeat coronary bypass or coronary angioplasty after CABG using saphenous vein grafts. Am J Cardiol. 1994, 73: 103-112. 10.1016/0002-9149(94)90198-8.CrossRefPubMed
9.
Kaul TK, Fields BL, Wyatt DA: Reoperative coronary artery bypass surgery: early and late results and management in 1300 patients. J Thorac Cardiovasc Surg. 1995, 36: 303-312.
10.
Fremes SE, Levington C, Naylor CD: Optimal antithrombotic therapy following aortocoronary artery bypass: a meta-analysis. Eur J Cardiothorac Surg. 1993, 7: 169-180. 10.1016/1010-7940(93)90155-5.CrossRefPubMed
11.
The Post CABG Trial Investigators: The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. N Engl J Med. 1997, 336: 153-62. 10.1056/NEJM199701163360301.CrossRef
12.
Taggart DP, D'Amico R, Altman DG: The effect of arterial revascularization on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet. 2001, 358: 870-5. 10.1016/S0140-6736(01)06069-X.CrossRefPubMed
13.
Lytle BW, Blackstone EH, Loop FD: Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg. 1999, 117: 855-872. 10.1016/S0022-5223(99)70365-X.CrossRefPubMed
14.
Endo M, Nishida H, Tomizawa Y, Kasanuki H: Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting. Circulation. 2001, 104 (18): 2164-70.CrossRefPubMed
15.
Sergeant P, Blackstone E, Meyns B: Validation and interdependence with patient-variables of the influence of procedural variables on early and late survival after CABG. Eur J Cardiothorac Surg. 1997, 12: 1-19. 10.1016/S1010-7940(97)00134-6.CrossRefPubMed
16.
Kurlansky PA, Traad EA, Galbut DL: Efficacy of single versus bilateral IMA grafting in women: a long-term study. Ann Thorac Surg. 2001, 71 (6): 1949-57. 10.1016/S0003-4975(01)02592-9. discussion 1957–8.CrossRefPubMed
17.
Schmidt SE, Jones JW, Thornby JI: Improved survival with multiple left-sided bilateral internal thoracic artery grafts. Ann Thorac Surg. 1997, 64: 9-15. 10.1016/S0003-4975(97)00473-6.CrossRefPubMed
18.
Verhelst R, Etienne PY, El Khoury G: Free internal mammary artery graft in myocardial revascularization. Cardiovasc Surg. 1996, 4: 212-6. 10.1016/0967-2109(96)82318-0.CrossRefPubMed
19.
Buxton BF, Ruengsakulrach P, Fuller J: The right ITA graft-benefits of grafting the left coronary system and native vessels with a high grade stenosis. Eur J Cardiothorac Surg. 2001, 18: 255-61. 10.1016/S1010-7940(00)00527-3.CrossRef
20.
Calafiore AM, Contini M, Vitolla G: Bilateral internal thoracic artery grafting: long-term clinical and angiographic results of in situ versus Y grafts. J Thorac Cardiovasc Surg. 2001, 120 (5): 990-6. 10.1067/mtc.2000.110249.CrossRef
21.
Dion R, Glineur D, Derouck D: Long-term clinical and angiographic follow-up of sequential internal thoracic artery grafting. Eur J Cardiothorac Surg. 2001, 17 (4): 407-14. 10.1016/S1010-7940(00)00370-5.CrossRef
22.
Taggart DP, Westaby S: Neurological and cognitive disorders after CABG. Curr Opin Cardiol. 2001, 16 (5): 271-6. 10.1097/00001573-200109000-00003.CrossRefPubMed
23.
Ioannidis JP, Galanos O, Katritsis D: Early mortality and morbidity of bilateral versus single ITA revascularization: propensity and risk modeling. J Am Coll Cardiol. 2001, 37 (2): 521-8. 10.1016/S0735-1097(00)01112-8.CrossRefPubMed
24.
Matsa M, Paz Y, Gurevitch J: Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus. J Thorac Cardiovasc Surg. 2001, 121 (4): 668-74. 10.1067/mtc.2001.112824.CrossRefPubMed
25.
Cohen AJ, Lockman J, Lorberboym M: Assessment of sternal vascularity with single photon emission computed tomography after harvesting of the ITA. J Thorac Cardiovasc Surg. 1999, 118 (3): 496-502. 10.1016/S0022-5223(99)70188-1.CrossRefPubMed
26.
Gurevitch J, Paz Y, Shapira I: Routine use of bilateral skeletonized internal mammary arteries for myocardial revascularization. Ann Thorac Surg. 1999, 68 (2): 406-11. 10.1016/S0003-4975(99)00460-9. discussion 412CrossRefPubMed
27.
Wendler O, Hennen B, Markwirth T: Complete arterial revascularization in the diabetic patient-early postoperative results. Thorac Cardiovasc Surg. 2001, 49 (1): 5-9. 10.1055/s-2001-9916.CrossRefPubMed
28.
Taggart DP: Biochemical assessment of myocardial injury after cardiac surgery: effects of a PAF antagonist, bilateral ITA grafts, and coronary endarterectomy. J Thorac Cardiovasc Surg. 2001, 120 (4): 651-9. 10.1067/mtc.2000.106325.CrossRef
29.
Taggart DP: Respiratory dysfunction after cardiac surgery: effects of avoiding cardiopulmonary bypass and the use of BIMA. Eur J Cardiothorac Surg. 2001, 18 (1): 31-7. 10.1016/S1010-7940(00)00438-3.CrossRef
30.
31.
Metadata
Title
Protocol for the Arterial Revascularisation Trial (ART). A randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularisation [ISRCTN46552265]
Authors
David P Taggart
Belinda Lees
Alastair Gray
Douglas G Altman
Marcus Flather
Keith Channon
the ART Investigators
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Trials / Issue 1/2006
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-7-7

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