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

er the one that is more invasive."

Surgery is more invasive than angioplasty, since it requires the chest to be cut open. Angioplasty is done by threading a flexible wire called a catheter through a blood vessel into the heart.

One shortcoming of the study is the relatively short follow-up period of 18 months, said Dr. Joseph P. Carrozza, an associate professor of medicine at Harvard Medical School, who wrote an accompanying editorial. "One would like to see patients followed for up to five years," said Carrozza, who is an interventional cardiologist at Beth Israel Deaconess Medical Center.

"There is nothing in this study that makes us feel surgery is the treatment of choice for patients with multi-vessel disease," he added. Such a verdict will have to wait on the results of several randomized trials now underway, Carrozza said. "This is just one piece of evidence we have right now before we get the final word," he noted.

And yet, Carrozza conceded, "this is the first really large study to look at this issue now" and thus should be considered by doctors and heart patients requiring treatment for blocked coronary arteries.

Another report in the same issue of the journal compared the safety of bare-metal to drug-coated stents for so-called "off-label" uses -- implants for conditions where there is no formal government approval. About half of all stent implants are for such conditions.

Questions have been raised about the safety of drug-coated stents in off-label conditions, said a report by a group led by Dr. Oscar C. Marroquin of the University of Pittsburgh. But the study of 6,551 cases found a lower rate of complications and no increased risk of death or heart attack for drug-coated stents as compared to the bare-metal kind. "These findings support the use of drug-eluting stents for off-label indications," the researchers wrote.

That report comes on the heels of a study of off-label use of a dif
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