Is Bypass Truly Better than Stenting?

Feb. 19 -- WEDNESDAY, Feb. 18 (HealthDay News) -- In people with severely blocked heart arteries, bypass surgery produced better results than angioplasty plus the implantation of a stent, and thus "remains the standard of care" in such cases, according to an international study.

But that assessment is disputed by one of the cardiologists involved in the study and an expert who wrote an accompanying editorial.

The benefits and disadvantages of both procedures are so evenly balanced, they said, that a decision on which should be used can be left in most cases to the person being treated.

The study, which was released Wednesday by the New England Journal of Medicine for its March 5 issue, included 1,800 people who had blockages of the left main coronary artery or three major heart arteries. Half had bypass surgery, and the other half had what is formally called percutaneous coronary intervention (PCI) -- typically angioplasty -- combined with an implanted stent, a tiny mesh tube that props open the vessel to keep blood flowing.

During the next year, 17.8 percent of those who had the stent procedure had "major adverse cardiac or cerebrovascular events," compared with 12.4 percent of those who had bypass surgery.

That demonstrated the superiority of surgery, the report said.

"But the important point is to read the fine print," said Dr. David R. Holmes Jr., professor of medicine at the Mayo Clinic Graduate School of Medicine, and one of the physicians involved in the study.

The death rate and occurrence of major coronary events such as heart attacks were the same in both groups, Holmes noted. The only major difference was in the need for repeat artery-opening procedures: 13.5 percent in the stenting group, 5.9 percent in the bypass group. There was a significantly higher risk of stroke in the bypass group -- 2.2 percent vs. 0.6 percent in the PCI group.

But the finding gives people who want to avoid surgery a viable option, "if they accept the possible need for more future procedures," Holmes said.