Advanced Analysis of 15-Year Outcomes in the Arterial Revascularization Trial: Implications for CABG Strategies

Research proposal

This DPhil in Clinical Epidemiology and Medical Statistics will include a 3-year project entitled “Advanced Analysis of 15-Year Outcomes in the Arterial Revascularization Trial: Implications for CABG Strategies.”

The Arterial Revascularization Trial (ART) is a large-scale international study that compared two different surgical methods for coronary artery bypass grafting (CABG). The trial sought to determine if using two arterial grafts (bilateral internal thoracic artery grafts) provides better long-term outcomes than using a single arterial graft with vein grafts. The DPhil project will use the newly available 15-year ART follow-up data to investigate critical clinical and methodological questions that could change cardiac surgery practice. While the 10-year results didn't show a difference in mortality between single and bilateral internal thoracic artery grafts, the long-term durability of arterial grafts may become apparent over a longer period.

Your research will address key questions, including:

• Diabetes and Grafting Strategies: How does the benefit of multiple arterial grafts evolve over 15 years in patients with diabetes?
• Total Arterial Revascularization: We'll compare long-term outcomes for patients who received total arterial grafts versus other grafting strategies.
• Long-Term Complications: You'll analyse the impact of perioperative complications like deep sternal wound infection and atrial fibrillation on very long-term outcomes.
• Age-Treatment Interaction: You will investigate how the effect of the different grafting strategies varies over time for different age groups.

This project offers the chance to learn advanced research techniques and answer some important methodological questions. You will:

• Learn advanced statistics: Gain in-depth knowledge of survival analysis, including Cox proportional hazards models and time-varying covariates. You will also learn Bayesian statistical methods to provide a complementary perspective to traditional analysis.
• Analyse complex data: Develop expertise in handling and analysing complex, longitudinal datasets over a 15-year period.
• Present your findings: Receive mentorship in scientific writing and presenting research at major international conferences, such as the prestigious European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting.

Related publications

1.         Taggart DP, Benedetto U, Gerry S, Altman DG, Gray AM, Lees B, et al. Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. New England Journal of Medicine. 2019 Jan 31;380(5):437–46.  https://doi.org/10.1056/nejmoa1808783

2.         Taggart DP, Audisio K, Gerry S, Robinson NB, Rahouma M, Soletti GJ, et al. Single versus multiple arterial grafting in diabetic patients at 10 years: the Arterial Revascularization Trial. Eur Heart J. 2022 Nov 21;43(44):4644–52. https://doi.org/10.1093/eurheartj/ehac199

3.         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 Dec 30;7(1):7. https://doi.org/10.1186/1745-6215-7-7

Research group and supervision team

The Centre for Statistics in Medicine is a group of statisticians within the Botnar Institute for Musculoskeletal Sciences. Founded by the late Professor Doug Altman, a key figure and founding member of the ART team, the group includes a number of statisticians focusing on a mixture of applied and methodological work. The group has supervised many DPhil students to completions and is currently hosting 5 DPhil students.

Your main supervisor will be Prof Jonathan Cook. Jonathan is an expert in the design, conduct, and analysis of randomized controlled trials, with a particular focus on surgical trials. As the Head of the Oxford Clinical Trials Research Unit Statistics Team, he has extensive experience supervising postgraduate students on trials methodology.

Your co-supervisors will be Dr Stephen Gerry and Professor Marcus Flather.

Dr Stephen Gerry is key statistician for the ART trial. He has extensive experience in statistical analysis, particularly for clinical trials. He has led the statistical work for several publications from the ART trial, including those on diabetic patients and age-related outcomes.

Professor Marcus Flather is a Co-Principal Investigator on the ART trial. Professor Flather is a leading expert in study design and project management for large-scale cardiovascular trials. He is a recognized authority in the field and a member of the ESC Guidelines Committee.

Training

The Botnar Institute plays host to the University of Oxford's Institute of Musculoskeletal Sciences, which enables and encourages research and education into the causes of musculoskeletal disease and their treatment. Training will be provided in techniques including epidemiology, biostatistics, common data models, causal inference, and real-world evidence methods and multi-sources data.

A core curriculum of lectures will be taken in the first term to provide a solid foundation in a broad range of subjects including musculoskeletal biology, inflammation, epigenetics, translational immunology, data analysis and the microbiome.  Students will also be required to attend regular seminars within the Department and those relevant in the wider University.

Students will be expected to present data regularly in Departmental seminars, the Centre for Statistics in Medicine seminars and to attend external conferences to present their research globally, with limited financial support from the Department.

Students will also have the opportunity to work closely with experts in the field of cardiothoracic surgery at Cornell University in the United States, and the opportunity to present their findings at national and international conferences.

Students will have access to various courses run by the Medical Sciences Division Skills Training Team and other Departments. All students are required to attend a 2-day Statistical and Experimental Design course at NDORMS (information will be provided once accepted to the programme).

How to Apply

Please contact the relevant supervisor(s), to register your interest in the project, and, if required, the departmental Education Team (graduate.studies@ndorms.ox.ac.uk), who will be able to advise you of the essential requirements for the programme and provide further information on how to make an official application.

Interested applicants should have, or expect to obtain, a first or upper second-class BSc degree or equivalent in a relevant subject and will also need to provide evidence of English language competence (where applicable). The application guide and form is found online and the DPhil will commence in October 2026.

Applications should be made to the following programme using the specified course code.

D.Phil in Clinical Epidemiology and Medical Statistics (course code: RD_NNRA1)

For further information, please visit http://www.ox.ac.uk/admissions/graduate/applying-to-oxford.