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Bypass Surgery, Drug-eluting Stents Possess Similar Risk and Outcome

Drug-eluting stent therapy and bypass surgery for coronary artery disease have about the same risk for a major cardiac event within 30 days after the procedures// , according to researchers.

The two also have similar outcomes three years after treatment. Patients with coronary arteries narrowed by atherosclerosis are often candidates for either bypass surgery to reroute the arteries' blood flow or a stent, which is a small mesh tube that helps keep arteries open after angioplasty, a procedure to open clogged arteries.

Previous studies have found that placing bare-metal stents is safer than bypass surgery. However, "bypass surgery is much more successful for restoring patients' blood flow in the long-term because arteries with traditional stents re-narrow in about one out of every three cases," said James M. Wilson, M.D., senior author of the study. The newer drug-eluting stents were developed to help keep arteries open longer, but until now their effectiveness had not been compared with the gold standard bypass surgery.

Wilson and colleagues analyzed 799 drug-eluting stent patients and 799 coronary bypass patients, comparing how they fared in the first 30 days after their procedures and during the next three years.

"What we found came as a bit of a surprise," said Wilson, program director of the Cardiology Fellowship Program at St. Luke's Episcopal Hospital and Texas Heart Institute in Houston. "We found that the likelihood of any complication in the hospital was the same whether you had a drug-eluting stent or bypass. Five percent of drug-eluting stent patients had some major complication in the hospital, mostly heart attack, as opposed to about 3.8 percent of the patients who had bypass. Those numbers, although seemingly different, are statistically the same."

"We have done further research since comparing drug-eluting to bare-metal stents and have found that the higher complication rate among drug-e
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