Stents safe, effective as bypass surgery for heart disease

Drug-eluting stents -- a less-invasive alternative to bypass surgery -- are as effective as surgery for many patients with a blockage in the left main coronary artery, a study has found.

Coronary artery bypass graft (CABG) surgery has long been considered the definitive treatment for patients with left main coronary artery disease (LMCAD), in which the artery that supplies oxygen-rich blood to most of the heart muscles is clogged with atherosclerotic plaque.

However, stents, which are placed into the diseased artery via a catheter that is inserted through a small opening in a blood vessel in the groin, arm, or neck, are a less-invasive treatment option for many people with coronary artery disease.

"Our study has shown that many patients with left main coronary artery disease who prefer a minimally invasive approach can now rest assured that a stent is as effective as bypass surgery for at least three-years, and is initially safer, with fewer complications from the procedure," said lead author Gregg W. Stone, Professor at Columbia University Medical Center.

Further, the researchers found that stent patients had a significantly lower incidence (4.9 per cent) of death, stroke, heart attack, or revascularisation than those who had bypass surgery (7.9 per cent) in the first 30 days after treatment, when serious complications are most likely to occur.

In addition, fewer stent patients had major bleeding, infections, kidney failure, or severe abnormal heart rhythms compared to those treated with surgery.

Bypass surgery should still be considered standard therapy for those with LMCAD and extensive blockages in the remainder of the heart arteries, although the study did not include patients with severe disease, the researchers suggested.

"While bypass is still considered a more durable repair, patients and doctors may prefer a percutaneous treatment approach, which is associated with better upfront results, fewer complications, and quicker recovery," Stone said.

For the study, 1,905 patients with LMCAD and low or intermediate coronary artery disease complexity, were randomised to receive a drug-eluting stent -- that releases the anti-proliferative agent everolimus -- or bypass surgery.

The patients were followed for at least two years, with a median follow-up of three years.

"We found that approximately 15 per cent of patients in both groups had a heart attack, stroke, or died within three years. In other words, stents were equally effective as bypass surgery," Stone noted in the paper published online in the New England Journal of Medicine.

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