ART

The aim of the ART study is to determine if the use of both internal mammary arteries (IMA) during coronary artery bypass graft (CABG) surgery improves survival, and reduces the need for further intervention (including surgery) compared to using one mammary artery. Patients will be followed up for 10 years after surgery.

TRIAL STATUS

• ART has now completed follow up and the findings have been published (view here).
• 3102 patients were enrolled into ART between June 30th 2004 and December 20th 2007 in 28 cardiac surgery centres in seven countries worldwide (Australia, Austria, Brazil, India, Italy, Poland, UK).
• The primary outcome of ART was survival at 10 years and the study was completed when all patients had been followed up for 10 years.
• The clinical outcomes at 1 year were reported and showed similar clinical outcomes for both bilateral IMA grafts and single IMA grafts. This provided evidence that the use of bilateral IMA grafts is feasible on a routine basis.
• The effects of on-pump versus off-pump surgery in ART were also reported and showed that the outcomes of contemporary CABG are excellent with low mortality, stroke, myocardial infarction and need for wound reconstruction and repeat revascularisation whether performed on-pump or off-pump.

PURPOSE 

Coronary artery bypass grafting (CABG) is well established as the best treatment for those with multiple diseased blood vessels of the heart (coronary heart disease).  Most patients undergoing CABG require 3 new blood vessels (grafts).  The standard operation, used in 80%-90% of all patients, is to use one of the mammary arteries (from inside the chest) and additional veins from the leg or an artery from the arm.

CABG provides excellent short and intermediate term success but its long-term success may be limited by failure of the veins that have been used to bypass the blood vessels of the heart. Ten years after CABG around ½ of vein grafts have become blocked or diseased although current drug therapy such as aspirin and statins (which lower cholesterol) may reduce this failure.  Blocked or diseased vein grafts means that the patient may develop recurrent angina (chest pain) and may require further treatment including the possibility of another operation. There is some circumstantial (but no definite) evidence that if both of the mammary arteries are used in the CABG operation instead of just one it may improve the longer-term outcome.