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Bypass Beats Stents for Diabetic Heart Patients: Study
Date:11/5/2012

By E.J. Mundell
HealthDay Reporter

MONDAY, Nov. 5 (HealthDay News) -- For a subset of heart patients who are both diabetic and have more than one clogged artery, bypass surgery appears to outperform the use of artery-widening stents, a major new trial finds.

The study adds more evidence that bypass is the preferred approach for this type of patient, according to experts discussing the findings Sunday at the annual meeting of the American Heart Association in Los Angeles.

"This has the potential to change clinical practice," said Dr. Alice Jacobs, director of the Cardiac Catheterization Laboratory and interventional cardiology at Boston Medical Center. In her commentary, she said the results of the new trial "add to the consistent evidence base supporting coronary artery bypass grafting as the preferred strategy for patients with diabetes and multi-vessel coronary heart disease."

The findings were also published online Nov. 4 in the New England Journal of Medicine.

In bypass surgeries, doctors reroute blood flow around a blocked artery using a grafted vessel taken from another part of the body. In stenting, doctors use a catheter to insert a thin metal mesh tube called a stent into the artery, to prop it open.

Bypass has typically outperformed stenting in trials done in the past, but some experts thought that was only because older stents tended to re-close too often. Over the past decade, new drug-eluting stents have been developed that work better at preventing vessel reclosure.

According to Jacobs, the new trial's launch "was fueled by the contention that drug-eluting stents would negate the advances of [bypass]."

But the trial, funded by the U.S. National Heart, Lung, and Blood Institute, found that even with the use of drug-eluting stents, bypass still came out on top -- at least for very sick, diabetic heart patients.

The study included 1,900 such patients, 83 percent
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