Study Finds Fewer Deaths With Heart Bypass vs. Stents

Another study has found that few deaths are associated with heart bypass surgery versus stent implantation. Stents are tiny wire-mesh tubes used to prop open arteries after doctors clear them of blockages.

The new research, published in the New England Journal of Medicine, reveals that older patients suffering from clogged heart arteries likely experience a lowered risk of death, over time, if they opt for bypass surgery and not angioplasty and stents, said The Associated Press (AP).

Bypass surgery involves physicians moving healthy areas of blood vessels from other parts of the body. This, explained The AP, creates detours around the clogged arteries that supply the heart with blood. In angioplasty, the damage is repaired via a tube that is pushed through a blood vessel; a miniscule balloon is then inflated to flatten the clogged area and a so-called “mesh scaffold”—a stent—is then placed there to keep the artery open, The AP added.

The research involved a comparison of both techniques and involved review of 190,000 Medicare patient records who were diagnosed with two or three clogged arteries, representing the largest study of its kind, said The AP. The research revealed that the death rates were similar one year after treatment in both cases; however, after four years, about 21% of the angioplasty patients died, versus 16% in the bypass group.

According to the researchers, overall patient health could have played a part in the surgery group; however, angioplasty is a safer option, they said. “You’re not making a mistake if you still have angioplasty,” especially if you are over 65 with only one or two blockages, said Dr. Kirk Garratt of Lenox Hill Hospital in New York, wrote the AP. Of note, Dr. Garratt is a spokesman for the Society for Cardiac Angiography and Interventions, a group of physicians who conduct angioplasties.

We recently wrote that other, new research found that stents could be linked to increased risk of stroke or death versus surgery; however, carotid endarterectomy, a procedure meant to clear these blockages, cold lead to nerve damage or heart attack. That research looked at 13 clinical trials comparing both options, a matter of debate for some time now.

We have long written about the controversy surrounding cardiac stents. Most recently, Reuters reported that diabetics diagnosed with stable heart disease may not need invasive stent implantation, angioplasty, or bypass surgery. That research might add to stent maker woes, including falling sales after prior studies revealed stents offered no better option over medication in stemming death and heart attacks in heart patients.

Another previous Reuters article cited the Occluded Artery Trial (OAT), findings and indicated that one year following stent implantation, patients were as unable to climb stairs as those not implanted, they spent substantially more on the procedures, and their quality of life was shorter after two years over those treated with medications only.

Of the more than 800,000 angioplasties conducted last year for a total of $10 billion, Duke University concluded that about half could have received comparable treatment via drugs, diet, and exercise, with less risk of re-clogging, according to a Bloomberg News report earlier this year, which cited the prior studies. Stent makers include Boston Scientific, Abbott Laboratories, Johnson & Johnson, and Medtronic Inc.