Nav: Home

Ten-year outcomes of the Arterial Revascularisation Trial revealed today

August 26, 2018

Munich, Germany - 26 Aug 2018: The ten-year outcomes of the Arterial Revascularisation Trial (ART) are presented today in a Hot Line Session at ESC Congress 2018.1

Coronary artery bypass graft (CABG) surgery is indicated in patients with angina and advanced coronary artery disease. With about one million operations per year globally, it is one of the most common major surgical procedures undertaken worldwide. Establishing the best methods for CABG is therefore a key element of successful management of patients with advanced coronary artery disease, who have narrowed coronary arteries and are at higher risk of limited exercise capacity due to angina (chest pain on exertion), myocardial infarction (heart attack), and death.

While it is firmly established that the use of one internal thoracic artery (arteries that supply the inner part of the chest wall) can improve life expectancy compared to vein grafts it is not known if there are additional benefits with the use of a second artery. ART tested whether routine use of two internal thoracic arteries, compared to the standard single internal thoracic artery, could reduce the risk of dying over a ten-year period in patients undergoing CABG surgery.

Between 2004 and 2007, the trial enrolled 3,102 patients with symptomatic coronary disease scheduled to undergo CABG at 28 centres in seven countries (UK, Poland, Australia, India, Brazil, Austria and Italy). A total of 1,548 patients were randomly allocated to bilateral and 1,554 patients to single internal thoracic artery grafts. Additional arterial or vein grafts were used at the discretion of the responsible surgeon. The primary outcome was death from any cause at ten years. The secondary outcome was a composite of death from any cause, myocardial infarction, or stroke.

The average age of participants was 64 years and 24% were women. In the bilateral graft group, 14% actually received a single internal thoracic artery graft, while 22% in the single internal thoracic artery group also received an additional radial artery graft.

At ten years 315 (20.4%) and 329 (21.2%) patients died in the bilateral and single graft groups, respectively (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.82-1.12, p=0.58). The secondary outcome occurred in 385 (24.9%) and 425 (27.4%) patients in the bilateral and single graft groups, respectively (HR 0.90, 95% CI 0.78-1.03, p=0.12). Results appeared to be more favourable in patients who had bilateral graft surgery done by surgeons who performed more operations in the trial.

In an exploratory analysis, patients who received any two arterial grafts (internal thoracic or radial) appeared to have a lower mortality (HR 0.79, 95% CI 0.64-0.97) and composite of death, myocardial infarction or stroke (HR 0.80, 95% CI 0.69-0.93) compared to those who received a single arterial graft. Although these findings are relevant they are not a randomised comparison and require confirmation in future trials.

Overall ART was not able to confirm that a strategy of routine bilateral internal thoracic artery grafting was superior to routine single internal thoracic artery grafting for patients undergoing CABG. Possible explanations include the high rate of patients who were randomised to receive a bilateral internal thoracic artery but actually received a single internal thoracic artery and in those assigned a single internal thoracic artery graft about one fifth actually received an additional arterial graft in the form of a radial artery. Both factors could have reduced the true efficacy of bilateral internal thoracic artery grafts. Furthermore, a high use of guideline directed medical therapy, including aspirin, statins, beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, in both groups may have narrowed any potential differences between the groups.

Professor David Taggart, Chief Investigator and Professor of Cardiac Surgery at the University of Oxford, UK, said: "ART is one the largest trials with the longest duration of follow-up ever undertaken in cardiac surgery to guide future practice with regards to conduit selection for CABG. While the trial did not show that using two internal thoracic arteries is superior to one, it raises the possibility that any two arterial grafts (internal thoracic or radial) may provide better outcomes than a single graft for patients undergoing CABG surgery."
Notes to editors

ART is sponsored by the University of Oxford and the trial was coordinated by the Clinical Trials and Evaluation Unit at the Royal Brompton and Harefield NHS Foundation Trust (London UK) and the Surgical Intervention Trials Unit at the University of Oxford, UK.

SOURCES OF FUNDING: British Heart Foundation, UK Medical Research Council and the UK National Institute of Health Research.


References and notes

1"ART - Randomised comparison of bilateral versus single internal thoracic coronary artery bypass graft surgery: effects on mortality at ten years follow-up in the Arterial Revascularisation Trial (ART)" will be discussed during:

* Press Conference - Hot Line - Late Breaking Clinical Trials 2 on Sunday 26 August at 09:30 CEST.

* Hot Line Session 2 on Sunday 26 August at 16:45 to 17:45 CEST in the Munich Auditorium.

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2018

ESC Congress is the world's largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2018 takes place 25 to 29 August at the Messe München in Munich, Germany. Explore the scientific programme.

More information is available from the ESC Press Office at

European Society of Cardiology

Related Myocardial Infarction Articles:

Exercise associated with improved heart attack survival
Exercise is associated with improved survival after a heart attack, according to research published today in the European Journal of Preventive Cardiology.
Preventing mortality after myocardial infarction
How much blood to give to anemic patients after a heart attack?
Follow-up by trained nurses helps myocardial infarction patients
The quality of life of elderly myocardial infarction patients can be significantly improved without extra costs by means of so-called case management following hospitalization.
Myocardial inflammation elevated in RA patients
Two new studies measure the prevalence of myocardial inflammation in RA patients without known cardiovascular disease, assess how it is associated with high disease activity and show how disease-modifying therapy may decrease this type of inflammation, according to new research findings presented this week at the 2016 ACR/ARHP Annual Meeting in Washington.
Higher education associated with reduced heart failure risk after myocardial infarction
Higher education is associated with a reduced risk of developing heart failure after a heart attack, reports a study in more than 70,000 patients published today in the European Journal of Preventive Cardiology.
Ticagrelor for prevention after myocardial infarction: Indication of minor added benefit
In high risk of developing atherothrombotic events, ticagrelor in combination with low-dose acetylsalicylic acid is now also approved if the infarction occurred more than a year ago.
Your blood can reveal your risk for heart disease
Traditional risk factors only explain a modest proportion of cardiac incidence.
Myocardial infarction: Rush-hour for neutrophils
Researchers at Ludwig-Maximilians-Universitaet (LMU) in Munich have shown that circadian oscillations in the influx of immune cells into the damaged tissue play a crucial role in exacerbating the effects of an acute heart attack in the early morning hours.
1 in 4 patients develop heart failure within 4 years of first heart attack
One in four patients develop heart failure within four years of a first heart attack, according to a study in nearly 25,000 patients presented today at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure by Dr.
Myocardial fibrosis identified as new therapeutic target
Myocardial fibrosis could be a future therapeutic target after researchers found it correlated with adverse cardiovascular outcomes in patients with obstructive sleep apnoea referred for cardiac magnetic resonance.

Related Myocardial Infarction Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#529 Do You Really Want to Find Out Who's Your Daddy?
At least some of you by now have probably spit into a tube and mailed it off to find out who your closest relatives are, where you might be from, and what terrible diseases might await you. But what exactly did you find out? And what did you give away? In this live panel at Awesome Con we bring in science writer Tina Saey to talk about all her DNA testing, and bioethicist Debra Mathews, to determine whether Tina should have done it at all. Related links: What FamilyTreeDNA sharing genetic data with police means for you Crime solvers embraced...