Angioplasty/Stenting Results Competitive with Bypass

Angioplasty and the use of drug-eluting stents are being compared to coronary artery bypass graft surgery in a study reported in the April 15 issue of the American Journal of Cardiology.  Due to the invasiveness of bypass surgery, which most often involves the use of a sternotomy and cardiopulmonary bypass (CPB), both of which are associated with morbidity that is markedly higher in older, frailer patients, angioplasty with stenting, as a catheter-based procedure performed on a beating heart requiring neither sternotomy nor CPB, has emerged as a very viable competitor to bypass and is progressively taking away patient volume in bypass caseload. 

From Medical News Today:

"With the advent of more minimally invasive heart procedures, the medical field is exploring additional options for treating patients beyond surgical standards," said Lee, an assistant professor of cardiology at the David Geffen School of Medicine at UCLA. "Studies such as ours will help us better understand the impact of these new procedures and their role as possible new treatment options."

The researchers performed a review of the literature and then analyzed mortality and risk factors in eight clinical studies comparing the two procedures. The clinical studies took place between 2000 and 2009 and involved more than 2,900 patients.

Researchers found that the risk of death or heart attack at one-year follow-up did not differ significantly between heart bypass surgery and angioplasty with drug-eluting stents. The risk of stroke was lower with stenting than with bypass surgery, but the risk of an artery re-clogging was significantly higher in patients receiving a stent.

"There are benefits and risks to both procedures and our analysis shows that for select patients, drug-eluting stenting may be a good alternative," Lee said. 

This study concurs in principle with other studies that have been performed indicating that bypass shows a nominal advantage in long term efficacy due to the incidence of restenosis associated with stents (even for drug-eluting stents), but for many patients angioplasty and stenting results are competitive with bypass, potentially even considering the need for repeat procedures.

Coronary stents — drug-eluting, bare metal, bioabsorbable — and other treatments for coronary artery disease are the subject of the MedMarket Diligence Report #C245, "Drug-Eluting, Bare Metal and Other Coronary Stents, Worldwide Market, 2008-2017."

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