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Dates: 2004-Ongoing
Funding: Medical Research Council
Collaborators: Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford;
Royal Brompton Hospital, London

Worldwide, around 800,000 coronary artery bypass grafts are performed annually, and in the UK, the National Service Framework (NSF) aims to increase numbers from 500 to 750 per million of population.

ART is a large multinational randomised trial to compare survival following bilateral versus single internal mammary (IMA) grafting in coronary revascularisation. The main outcome measure in the trial is death from any cause (cardiovascular and non-cardiovascular mortality). 3102 patients had been recruited by December 2007 in 19 centres in Europe and Australia.  They will be followed for 10 years.

In line with the main outcome of the trial, the primary economic outcome measure in the cost-effectiveness analysis will be life years gained. These will be estimated over the patients' lifetimes, by taking the sum of life years obtained in each arm of the trial within the follow-up period and modelling subsequent life expectancy, using different assumptions about any within-trial treatment effects continuing. A cost per quality adjusted life year will be calculated in the same way, using results from the EQ-5D annual questionnaires. The costing exercise will report information on the surgical procedure resource use and subsequent follow-up costs. The multinational nature of the dataset will be considered when presenting the results of the trial.

An economic analysis comparing the costs associated with bilateral and single internal mammary artery grafting up to one year after surgery was published in the journal Heart in April 2017


One-year costs of bilateral or single internal mammary grafts in the Arterial Revascularisation Trial.

Gray AM., Murphy J., Altman DG., Benedetto U., Campbell H., Flather M., Gerry S., Lees B., Taggart DP. Heart. EPub: 10.1136/heartjnl-2016-311058.

Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the Arterial Revascularization Trial (ART)

Benedetto U., Altman DG., Gerry SW., Gray A., Lees B., Flather M., Taggart DP (2017). European Journal of Cardio-Thoracic Surgery. EPub:

Randomized trial of bilateral versus single internal-thoracic-artery grafts

Taggart DP. et al, (2016), New England Journal of Medicine, 375, 2540 - 2549

Effects of on-pump and off-pump surgery in the Arterial Revascularization Trial.

Taggart DP. et al, (2015), Eur J Cardiothorac Surg, 47, 1059 - 1065

Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART).

Taggart DP. et al, (2010), Eur Heart J, 31, 2470 - 2481

Pedicled and skeletonized single and bilateral internal mammary artery grafts 4 and the incidence of sternal wound complications: Insights from the Arterial 5 Revascularization Trial (ART)

Benedetto B., Altman DG., Gerry S., Gray A., Lees B., Pawlaczyk R., Flather M., Taggart DP. Eur J Cardiothorac Surg.

Protocol for the Arterial Revascularisation Trial (ART). A randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularisation [ISRCTN46552265]

Taggart DP, Lees B, Gray A, Altman DG, Flather M, Channon K and the ART Investigators (2006) Trials 2006 7:7 doi:10.1186/1745-6215-7-7.