Heart patients with more than one clogged artery benefit most
from bypass surgery when compared to drug-coated stents, according
to a recent study.
The new research puts a damper on hopes the less invasive stent
procedure would prove to be just as good for people with multiple
blockages.
In the study, heart attack and death rates were lower among
people who had surgery than those given artery-opening balloon
angioplasty and stents -- mesh cylinders dripping drugs to keep
vessels from reclogging.
It is latest setback for drug-coated stents, which have
revolutionized heart care and have been implanted in about 6
million people worldwide. They are far better at keeping vessels
open than older bare metal stents. However, sales have been hurt in
the past year by safety concerns and studies questioning the value
of angioplasty itself for certain patients.
A second study gave stent makers some good news, finding that
using these devices "off label," in non-approved situations, is not
as dangerous as many had feared.
Both studies were published in Thursday's New England Journal of
Medicine. Neither is definitive enough to resolve these issues, but
they help guide doctors and patients confused about which treatment
is best for whom.
The bypass study is "a sobering reality check" for people hoping
that the newer drug-coated stents "would level the playing field"
and make these treatments equally effective, Harvard University
cardiologist Dr. Joseph Carrozza wrote in an accompanying
editorial.
Bypass surgery has become less common as angioplasty has risen
dramatically. In 2005, about 469,000 bypasses were performed on
261,000 patients. More than 1.2 million angioplasties were done,
though many people had more than one procedure.
(Xinhua News Agency January 25, 2008)