Current Weather
The Spy FM

Bypass Surgery Edges Stents For Heart Treatment

Filed by KOSU News in Health.
March 27, 2012

The debate over coronary bypass surgery versus stenting goes back decades.

Studies have been inconclusive, but doctors and patients have voted with their feet in favor of the less-invasive procedure — clearing clogged arteries and propping them open with tiny scaffolds called stents.

U.S. doctors do at least two stenting procedures these days for every coronary bypass operation.

Now the biggest collection of cases so far comes out in favor of surgery on the all-important question of mortality. Four years after the procedure, patients over 65 who had coronary artery bypass surgeries (called CABG or “cabbages”) were almost 20 percent less likely to die.

Put another way, 21 percent of stented patients had died after four years compared with 16 percent of surgery patients.

Is that a big difference? Well, the study’s lead author tells Shots that it might be enough to “tip the balance a little bit, but not overwhelmingly so.”

Dr. William Weintraub, chief of cardiology at Christiana Care Health System in Newark, Del., is presenting the data at the annual meeting of the American College of Cardiology in Chicago. The study also appears online in the New England Journal of Medicine.

It draws on data from more than 86,000 patients across the nation who underwent CABG operations and nearly 104,000 patients who had coronary stenting. They had blockages in either two or three coronary arteries but did not require emergency procedures.

Although the pro-surgery outcome is not a game-changer, Weintraub says it might cause some doctors and patients to consider surgery. And he says it supports those who now opt for CABGs.

“It’s a very big deal to recommend coronary surgery to patients,” Weintraub says. “I think doctors work very hard to weigh what’s best for their patients. When doctors recommend surgery, these data suggest that that decision is a good one.”

But Dr. Laura Mauri says in an accompanying editorial that the new study can’t settle any debates. Only studies that randomly assign comparable patients to surgery or stenting can do that. Mauri is an interventional cardiologist – i.e., a specialist who does coronary stenting – at Brigham and Women’s Hospital inBoston.

Weintraub notes it’s “very difficult and expensive” to do randomized studies on this question – and to make the comparison groups truly comparable. And while such a study is being done, the technology (especially stenting technology) changes. That can call into question the ultimate relevance of the findings.

So the new data may be the best that doctors and patients in this situation can expect for the foreseeable future. [Copyright 2012 National Public Radio]

Leave a Reply

9AM to 10AM Car Talk

Car Talk

Listen Live Now!

10AM to 11AM Wait Wait...Don't Tell Me!

Wait Wait...Don't Tell Me!

Peter Sagal and Carl Kasell host the weekly NPR News quiz show alongside some of the best and brightest news and entertainment personalities.

View the program guide!

11AM to 12PM This American Life

This American Life

Take in a slice of Americana with critically acclaimed host Ira Glass on "This American Life." Each week he picks a theme, then gives his writers and performers the freedom to weave real stories from real people around that theme in a manner they find most engaging.

View the program guide!

Upcoming Events in your area (Submit your event today!)

Streaming audio and podcasts

Stream KOSU on your smartphone

Phone Streaming

SmartPhone listening options on this page are intended for many iPhones, Blackberries, etc. with low-cost software applications available to listen to our full-time web streams, both News on KOSU-1 and Classical on KOSU-2.

Learn more about our complete range of streaming services

We're perfecting the patient experience - Stillwater Medical Center