ART (Arterial Revascularisation Trial) is led by Professor David Taggart, Professor of Cardiovascular Surgery, University of Oxford.
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.
- 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.
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.
The primary results publication (2019) can be found here.
Secondary results publications can be found at the following links:
1: Five-year costs from a randomised comparison of bilateral and single internal thoracic artery grafts (2019)
2: Incidence and clinical implications of intraoperative bilateral internal thoracic artery graft conversion: Insights from the Arterial Revascularization Trial (2018)
3: Off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial (2018)
4: Safety of Perioperative Aprotinin Administration During Isolated Coronary Artery Bypass Graft Surgery: Insights From the ART (Arterial Revascularization Trial) (2018)
5: Associations Between Adding a Radial Artery Graft to Single and Bilateral Internal Thoracic Artery Grafts and Outcomes (2017)
6: One-year costs of bilateral or single internal mammary grafts in the Arterial Revascularisation Trial (2017)
7: Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1-year outcomes in the Arterial Revascularisation Trial (2017)
8: Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial (2016)
9: Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts (2016)
10: Effects of on-pump and off-pump surgery in the Arterial Revascularization Trial (2015)
11: Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART) (2010)
The study protocol publication can be found here.
The ART trial's privacy notice can be viewed by clicking the link below.
Senior Trial Manager
15-year Follow-up study awarded BHF funding
The findings from the 10-year outcomes of ART has encouraged the trial team to continue to follow up the ART patients for at least 15 years after their coronary artery bypass grafting (CABG) surgery. The 15-year follow-up will further investigate the comparison between bilateral internal mammary artery (BIMA) and single internal mammary artery (SIMA) grafts in CABG surgery. We are pleased to announce that the 15-year follow-up study for ART has been awarded funding by the British Heart Foundation (BHF). The study will evaluate survival and other clinical events in research participants for at least 15 years after their CABG surgery. The findings will help to assess the long-term benefits of BIMA compared to SIMA grafts and will be one of the first international multi-centre randomised clinical trials in cardiovascular surgery with 15 years of follow-up.