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Surgery Better Than Stents for Multiple Blockages
Date:1/23/2008

Fewer deaths, heart attacks found in 18-month study

WEDNESDAY, Jan. 23 (HealthDay News) -- Bypass surgery provides a lower risk of death and heart attacks than stents for people with blockages of at least two heart arteries, a large-scale study indicates.

The finding is far from the last word on the stent-versus-surgery debate in such cases, said study author Dr. Edward L. Hannan, associate dean for research at the State University of New York at Albany School of Public Health. "But there isn't any other study right now that is better than this," he added.

"Physicians need to inform patients about these results and need to engage in a dialogue that includes these findings to determine what is the proper treatment for multi-vessel disease," Hannan said.

Hannan and his colleagues studied the outcomes of more than 17,400 procedures for people with multiple blocked coronary arteries. The outcomes were consistently better in an 18-month follow-up for bypass surgery than for the artery-opening procedure called angioplasty followed by insertion of a drug-coated tube known as a stent.

For example, 92.1 percent of those who had surgery for three blocked arteries had no heart attacks and were alive, compared to 89.7 percent of those who got stents. For those with two blocked arteries, the comparable numbers were 94.5 percent for surgery and 92.5 for stent implants.

The study was not the kind of randomized, controlled trial regarded as the gold standard for medical research. It was observational, meaning that the researchers simply recorded what happened in medical practice rather than trying to control all the factors involved in choosing a treatment.

"But the randomized trials done in the past have not necessarily been better," Hannan said. "They were restricted to patients who were not very sick, and they also did not recognize that when you compare two treatments, some patients might not pref
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