Study into treatments for Britain’s number one health problem, coronary heart disease

A 12-year, 3,000-patient study into treatments for Britain’s number one health problem, coronary heart disease, has been launched this summer.

The study, called ART (Arterial Revascularisation Trial), is funded by the Medical Research Council and British Heart Foundation. Approximately 20 UK hospitals will be participating in the study, which aims to enrol 3000 patients and follow them for 10 years after coronary artery bypass surgery.

Coronary heart disease is the number one health problem in the UK. Coronary artery bypass grafting (CABG) is well established as the best treatment for those with multiple diseased blood vessels of the heart. Most patients undergoing CABG require 3 new blood vessels (grafts). The standard operation, used in 80-90 per cent of patients, uses one of the mammary arteries (from inside the chest) and additional veins from the leg or an artery from the arm. This is the single internal mammary artery (SIMA) procedure. The aim of the ART study is to determine if the use of both mammary arteries (BIMA) improves survival.

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 perform the bypass. Ten years after CABG around half of vein grafts are blocked or diseased, although current drug therapy such as aspirin and statins (which lower cholesterol) may reduce this failure. However, failure of vein grafts means that the patient may develop recurrent angina (chest pain) or even a heart attack, and may require further treatment, including the possibility of another operation.

There is some evidence that if both of the mammary arteries are used in the CABG operation instead of just one (the ‘BIMA’ procedure) the longer-term outcome may be improved. However, using both mammary arteries is a slightly more complex operation, takes an extra half-hour to do and may lead to a small increase in healing problems of the chest wound.

The aim of the ART study is to determine if the use of both mammary arteries (BIMA) improves survival, and reduces the chance of recurrent angina and/or the need for further intervention (including surgery) compared to using one mammary artery (SIMA).

ART involves most of the major cardiac centres in the UK, one in Italy and one in Australia. The Chief Investigator is Mr David Taggart, a consultant cardiac surgeon at the John Radcliffe Hospital and the University of Oxford. Mr Taggart and a panel of experts chaired by Professor Peter Sleight (Emeritus Professor of Cardiovascular Medicine at the University of Oxford) will oversee the conduct of the study. ART will be co-ordinated by the Clinical Trials and Evaluation Unit at the Royal Brompton Hospital. The trial started in June 2004 and will be completed by 2016.