Bypass trumps coated stents for multiple clogs, study says

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LOS ANGELES (AP) — Bypass surgery remains the best option for heart patients with more than one clogged artery, according to the first big study to compare bypass with drug-coated stents.

The new research dims hopes that the less-drastic 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 among those given artery-opening balloon angioplasty and stents.

It is the 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 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 today’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.

Blocked arteries cause chest pain by depriving the heart of needed blood, and can lead to a heart attack. One solution is bypass surgery, which reroutes blood vessels around blockages. Angioplasty has emerged as a nonsurgical alternative, in which a balloon is pushed into a blood vessel and inflated to flatten the clog, and stents are placed to keep the artery open.

Bypass 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.

Researchers analyzed two state databases of 17,400 New York residents treated for multiple blockages in 2003 and 2004, and compared deaths and complications 18 months later.

People with three clogged arteries had a survival rate of 94 percent after bypass compared with about 93 percent after stenting, which translated to a 20 percent lower risk of death. Those with two blockages had a survival rate of 96 percent after the operation compared with roughly 95 percent after stenting — about a 30 percent lower risk of death. The bypass group also needed fewer repeat procedures and suffered fewer heart attacks after treatment.

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