Choosing between percutaneous coronary intervention and coronary artery bypass grafting for patients with multivessel disease - What can we learn from the arterial revascularization therapy study (ARTS)?

What then, are physicians to learn from the 3-year follow-up of the ARTS trial? This report confirms and builds on the results of earlier analyses from ARTS and the other trials of PCI versus CABG in patients with multivessel coronary artery disease. The frequency of death and infarction are approximately equivalent when one compares an initial strategy of PCI versus CABG. The frequency of repeat revascularization procedures is lower with stents than was previously reported with balloon angioplasty; it is still greater than CABG in the first 3 years after placement of a bare stent but will be lower when drug-eluting stents are used. The need for more frequent repeat revascularization procedures associated with bare stents versus CABG at 3 years reduces the cost savings initially associated with PCI with bare stents versus CABG. Understanding the clinical and economic impact of using drug-eluting stents to treat patients with multivessel disease, and in particular those high-risk patients with diabetes mellitus and chronic kidney disease, awaits further trials.