Condition category
Circulatory System
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status

Plain English Summary

Background and study aims
A coronary artery bypass graft (CABG) is a surgical procedure that diverts blood around narrowed or clogged arteries of the heart to improve blood flow and oxygen supply to the heart. CABG surgery provides excellent short and intermediate term success in treating coronary heart disease 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. The artery grafts last better than the vein grafts. 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 aim of this study is to determine if the use of both mammary arteries improves survival, and reduces the chance of recurrent angina and/or the need for further intervention (including surgery) compared to using one mammary artery. Patients will be followed up for 10 years after surgery.

Who can participate?
CABG patients with coronary heart disease.

What does the study involve?
Patients are randomly allocated to receive either a single internal mammary artery (SIMA) graft or a bilateral internal mammary artery (BIMA) graft during their CABG surgery. Patients are then followed up every year for up to 10 years after their surgery. Data is collected on their health status and quality of life.

What are the possible benefits and risks of participating?
The possible disadvantages and risks of taking part are common to all patients undergoing CABG surgery.The possible disadvantages of BIMA grafting is that there may be a slightly increased risk of poor wound healing. The risk of poor wound healing with the standard SIMA operation is 1%-2% and this may increase by a further 1% in the BIMA group. However, this is usually only a problem in those with diabetes, or who are already very overweight or have severe breathing problems. A further consideration is that BIMA grafting has a slightly longer operation time (approximately 30 minutes in a three hour procedure) than SIMA grafting. Patients taking part in the study will be asked to complete quality of life questionnaires which may be regarded by some as an inconvenience. Both the SIMA grafting and the BIMA grafting should help treat the patient’s coronary heart disease. The possible advantages of BIMA grafting are that there may be a reduced risk of angina, heart attack and a requirement for further intervention, including the possibility of a second CABG operation in the long term. It is not possible to say definitively which type of grafting is better but the information from this study should help to decide the best treatment in the future for patients with coronary heart disease.

Where is the study run from?
Department of Cardiothoracic Surgery, The John Radcliffe (UK)

When is the study starting and how long is it expected to run for?
July 2004 to June 2014

Who is funding the study?
1. British Heart Foundation (UK)
2. Medical Research Council (UK)

Who is the main contact?
Prof. David Taggart

Trial website

Contact information



Primary contact

Prof David Taggart


Contact details

Department of Cardiothoracic Surgery
The John Radcliffe
Headley Way
United Kingdom

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Arterial Revascularisation Trial - a randomised trial to compare survival following bilateral versus single internal mammary artery (IMA) grafting in coronary revascularisation



Study hypothesis

The main objective is to assess whether the use of both IMA during coronary artery bypass graft (CABG) surgery improves survival and reduces the need for further interventions over that observed with a single IMA.

Ethics approval

HRA North East-York, 09/04/2004, ref: 04/3/006

Study design

Randomised controlled trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details to request a patient information sheet




Patients will be randomised to single internal mammary artery (SIMA) grafting or bilateral internal mammary artery (BIMA) grafting with supplemental vein or radial artery grafts as required.

Intervention type



Drug names

Primary outcome measure


Secondary outcome measures

1. Cause-specific mortality
2. 30 day mortality
3. Need for re-intervention by percutaneous coronary intervention or redo surgery
other clinical events
4. Quality of life (SF36, Rose and EuroQol)
5. Cost-effectiveness

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

Coronary artery bypass graft (CABG) patients with multi-vessel coronary artery disease (including urgent and off pump CABG patients)

Participant type


Age group




Target number of participants


Total final enrolment


Participant exclusion criteria

1. Single graft
2. Redo CABG
3. Evolving myocardial infarction
4. Concomitant valve surgery

Recruitment start date


Recruitment end date



Countries of recruitment

Australia, Austria, Brazil, India, Italy, Poland, United Kingdom

Trial participating centre

Department of Cardiothoracic Surgery, The John Radcliffe
Headley Way Headington
United Kingdom

Sponsor information


University of Oxford (UK)

Sponsor details

University Offices
Wellington Square
United Kingdom

Sponsor type




Funder type


Funder name

British Heart Foundation (SP/03/001)

Alternative name(s)


Funding Body Type


Funding Body Subtype


Funder name

Medical Research Council (G0200390)

Alternative name(s)


Funding Body Type


Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

2006 protocol in:
2010 results in:
2011 assessment of data quality in:
2014 results in:
2016 results in:
2016 results in:
2017 results in:
2017 results in:
2018 results in:
2019 results in:
2019 results in: (added 11/06/2020)

Publication citations

  1. Protocol

    Taggart DP, Lees B, Gray A, Altman DG, Flather M, Channon K, , Protocol for the Arterial Revascularisation Trial (ART). A randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularisation [ISRCTN46552265]., Trials, 2006, 7, 7, doi: 10.1186/1745-6215-7-7.

  2. Results

    Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu LM, Campbell H, Flather M, , Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART)., Eur. Heart J., 2010, 31, 20, 2470-2481, doi: 10.1093/eurheartj/ehq318.

  3. Assessment of data quality

    Krzych LJ, Lees B, Nugara F, Banya W, Bochenek A, Cook J, Taggart D, Flather MD, Assessment of data quality in an international multi-centre randomised trial of coronary artery surgery., Trials, 2011, 12, 212, doi: 10.1186/1745-6215-12-212.

  4. Results

    Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu LM, Flather M, , Effects of on-pump and off-pump surgery in the Arterial Revascularization Trial., Eur J Cardiothorac Surg, 2014, doi: 10.1093/ejcts/ezu349.

Additional files

Editorial Notes

11/06/2020: Publication reference and total final enrolment number added. 11/02/2019: Publication reference added. 07/03/2018: Publication reference added. 05/06/2017: Publication reference added. 02/05/2017: Publication reference added. 20/12/2016: The overall trial end date has been updated from 30/06/2014 to 30/06/2017 and a publication reference has been added. 29/09/2016: Added plain English summary. Added date of ethics approval. 15/08/2016: Publication reference added. Changed recruitment end date from 30/06/2014 to 20/12/2007. Updated trial website URL.