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Bypass Surgery, Stents Seem to Bring Same Level of Relief
Date:3/17/2011

By Randy Dotinga
HealthDay Reporter

WEDNESDAY, March 16 (HealthDay News) -- New research suggests that certain heart patients will fare about the same whether they have heart bypass surgery or a less-invasive procedure that uses drug-coated stents to prop open clogged arteries.

The findings may boost the appeal of stent procedures, which also require much less recovery time. However, patients with the most severe disease did do better with bypass surgery.

Regardless of whether a patient with chest pain undergoes a bypass or stent operation, "the message is that they can feel comfortable" with their decision, said study author Dr. David J. Cohen, director of cardiovascular research at Saint Luke's Mid America Heart Institute in Kansas City, Mo. "The degree of symptom relief is very comparable."

The vast majority of patients with coronary artery disease -- about 90 percent -- "do just fine" when they take medications to combat their clogged arteries, said Dr. Kirk N. Garratt, associate director of the division of cardiac interventions at Lenox Hill Heart and Vascular Institute in New York City. But the rest of heart patients need an operation to stop chest pain, he noted.

Bypass operations used to be the standard treatment, but stent operations have become more common in recent decades. Surgeons prop open clogged vessels with stents through a procedure called an angioplasty, and patients typically recover within days instead of weeks or months.

The problem, Garratt said, is that the body tries to heal the injury after the operation with scar tissue that can be harmful. Over the last decade, however, stents have started to come with drug coatings that discourage scar tissue from forming.

The new study, funded by stent manufacturer Boston Scientific Inc., aimed to determine how patients fared in terms of quality of life after getting bypasses or treatments with stents.

The researchers randomly assigned 1,800 heart patients to undergo either bypass surgery or a stent procedure. These patients had either three-vessel or left main coronary artery disease. The study authors followed up six and 12 months later to see how the patients were doing.

At a year, 76 percent of bypass patients said they were free of chest pain, also known as angina; 72 percent of stent patients said they were, according to the report.

"I'm not sure that this is earthshaking," said Garratt. "It was a fully predictable finding, considering what we already knew."

There are other factors for patients to think about before getting an operation. Stent patients face a higher need for repeat operations than bypass patients, Cohen noted. "If a patient has a strong aversion to coming back, a bypass operation is going to be more durable. It will last longer and keep them out of the hospital longer."

And patients with the most complex cases will fare better -- both in terms of quality of life and lifespan -- after a bypass, Cohen said.

In general, though, "if you're one of the unlucky few that need more than medicine to take care of your heart disease, both surgery and angioplasty promise to give you excellent results," Garratt said.

They won't necessarily help you live longer, however. Neither procedure has been shown to boost lifespan by a meaningful amount, Garratt said, except for heart attack patients. "What they add," he said, "is quality of life."

The findings are published in the March 17 issue of the New England Journal of Medicine.

More information

For more about heart disease, try the U.S. National Library of Medicine.

SOURCES: David J. Cohen, M.D., director, cardiovascular research, Saint Luke's Mid America Heart Institute, Kansas City, Mo.; Kirk N. Garratt, M.D., M.Sc., associate director, division of cardiac interventions, Lenox Hill Heart and Vascular Institute of New York, New York City; March 17, 2011, New England Journal of Medicine


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