Navigation Links
Is Bypass Truly Better than Stenting?
Date:2/18/2009

Read the fine print, experts say in disputing new study's finding,,

WEDNESDAY, Feb. 18 (HealthDay News) -- In people with severely blocked heart arteries, bypass surgery produced better results than angioplasty plus the implantation of a stent, and thus "remains the standard of care" in such cases, according to an international study.

But that assessment is disputed by one of the cardiologists involved in the study and an expert who wrote an accompanying editorial.

The benefits and disadvantages of both procedures are so evenly balanced, they said, that a decision on which should be used can be left in most cases to the person being treated.

The study, which was released Wednesday by the New England Journal of Medicine for its March 5 issue, included 1,800 people who had blockages of the left main coronary artery or three major heart arteries. Half had bypass surgery, and the other half had what is formally called percutaneous coronary intervention (PCI) -- typically angioplasty -- combined with an implanted stent, a tiny mesh tube that props open the vessel to keep blood flowing.

During the next year, 17.8 percent of those who had the stent procedure had "major adverse cardiac or cerebrovascular events," compared with 12.4 percent of those who had bypass surgery.

That demonstrated the superiority of surgery, the report said.

"But the important point is to read the fine print," said Dr. David R. Holmes Jr., professor of medicine at the Mayo Clinic Graduate School of Medicine, and one of the physicians involved in the study.

The death rate and occurrence of major coronary events such as heart attacks were the same in both groups, Holmes noted. The only major difference was in the need for repeat artery-opening procedures: 13.5 percent in the stenting group, 5.9 percent in the bypass group. There was a significantly higher risk of stroke in the bypass group -- 2.2 percent vs. 0.6 percent in the PCI group.

But the finding gives people who want to avoid surgery a viable option, "if they accept the possible need for more future procedures," Holmes said.

Until now, "patients in a study like this would have been told that the treatment of choice was bypass surgery, and there wasn't any good data to make a decision because it hadn't been studied in any rigorous way," he said. "This study looks at the most complex group of patients with the most extensive disease that has ever been looked at."

With the study results in hand, Holmes said, "the physician can present the data, but the patient is the one who can make the choice."

That's a course that many physicians might choose, said Dr. L. David Hillis, chairman of the department of medicine at the University of Texas Health Science Center in San Antonio, and co-author of the editorial.

"I think it's dealer's choice," he said. "I present the patient with two options. Some choose one, and some choose the other."

Some people are so fearful of the possible problems of bypass surgery that they will choose the stenting procedure despite the increased chance that they might need a second procedure in the year ahead, Hillis said. Others will opt for the certainty of surgery.

However, there are cases in which the decision has to be made by the doctor, he said. People who are unable or unwilling to take the clot-preventing medications, such as aspirin or Plavix, would not be suitable for stenting and "should be strongly encouraged to have surgery," Hillis said. "Then there are patients who for some reason have another disease entity that makes surgery a risk -- a bad lung condition, for example." Such conditions are found in 5 to 10 percent of cases, he said.

But generally, Hillis said, many physicians will let the patient choose. "I haven't taken a poll, but I think most would sit down and present the options to the patients."

Another report in the same issue of the journal affirmed the finding of a major study done two years ago that drug therapy was as effective alone as with stenting for people treated for heart attacks days or weeks after they occurred.

The new study, by physicians at Duke University, found that stenting did produce some temporary improvement in the quality of life but that the long-term benefits did not differ from those of drug treatment alone.

More information

The Cleveland Clinic has more on coronary artery disease.



SOURCES: David R. Holmes Jr., M.D., professor of medicine, Mayo Clinic Graduate School of Medicine, Rochester, Minn.; L. Davis Hillis, M.D., chairman, department of medicine, University of Texas Health Science Center, San Antonio, Texas; March 5, 2009, New England Journal of Medicine


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Restricting Blood Flow May Help Heart Bypass Patients
2. Bypass Off-Pump Boosts Womens Outcomes
3. Rehabilitation significantly underused after heart attack and bypass surgery
4. Angioplasty Equals Bypass Surgery for Heart Patients: Study
5. Lung Bypass Could Fight Emphysema
6. Statins After Bypass Lower Stroke Risk
7. Video: Patient at Mother Frances Receives Heart Bypass Without Opening Chest
8. Researchers at Peoria Pulmonary Associates to study airway bypass procedure for emphysema
9. Stents Slightly Better Than Bypass for Blocked Left Coronary Artery
10. Cardicas C-Port Anastomosis Systems for Coronary Artery Bypass Graft Procedures to be Used to Train Cardiothoracic Surgeons at Society of Thoracic Surgeons (STS) University
11. New York Methodist Hospital to study airway bypass treatment for emphysema
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Is Bypass Truly Better than Stenting? 
(Date:6/24/2016)... ... June 24, 2016 , ... EB Medicine presented ... in Emergency Medicine conference in Ponte Vedra Beach, FL. The awards honor the ... Emergency Medicine Practice and Pediatric Emergency Medicine Practice. , “With this award, ...
(Date:6/24/2016)... ... June 24, 2016 , ... Strategic Capital Partners, LLC ... by obtaining investment capital for emerging technology companies. SCP has delivered investment ... resulted in more than a million dollars of capital investment for five companies. ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... induced pluripotent stem (iPS) cells and other difficult to transfect cells, announces its ... The PluriQ™ G9™ Gene Editing System is a complete system for ...
(Date:6/24/2016)... ... June 24, 2016 , ... To succeed under value-based payments, ... are unsure how to move forward, given the need to sustain current operations. ... tailored to an organization’s specific needs. , PYA Principal Martie Ross states, “Healthcare ...
(Date:6/24/2016)... ... 24, 2016 , ... SpiritQuest Sedona Retreats, located in Arizona has re-located to ... vortex sites: Cathedral Rock, Airport Mesa, and Boynton Canyon. The new retreat center ... as well as the Sedona Rouge, both popular accommodations for SpiritQuest clients. The ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... Research and Markets has announced the addition ... Chemical (Sugar, Petrochemical, Glycerin), Inorganic Chemical), Functionality (Filler, Binder, ... Forecast to 2021" report to their offering. ... excipients market is projected to reach USD 8.1 Billion ... forecast period 2016 to 2021. The ...
(Date:6/23/2016)... Research and Markets has announced the ... report to their offering. ... favourable commercial environment for MedImmune to enter. The US ageing ... serve to drive considerable growth for effective anti-influenza medications. The ... sales considerably, but development is still in its infancy. ...
(Date:6/23/2016)... , June 23, 2016 ... Oticon , industry leaders in advanced ... launch of Oticon Opn ™, the world,s first ... of possibilities for IoT devices.      (Photo: ... Oticon introduces a number of ,world firsts,: ...
Breaking Medicine Technology: