Abstract
BackgroundStandard 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/DesignTwenty 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.DiscussionThe 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.
Highlights
Standard coronary artery bypass graft surgery uses a single internal mammary artery and supplemental vein or radial artery grafts
The results suggested a survival advantage for Bilateral internal mammary artery (BIMA) grafts (HR for death = 0.81, 95%CI: 0.70 to 0.94) without any evidence of a detrimental effect, there was very limited evidence relating to secondary endpoints including possible adverse consequences
In the largest single study [13], of 8000 single internal mammary artery (SIMA) and 2000 BIMA patients, Lytle et al reported that the hazard ratio (HR) for death was decreased by 23% in the BIMA group at 12 years and the need for redo Coronary artery bypass graft (CABG) reduced from 40% in the SIMA to 10% in the BIMA group
Summary
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.
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