Cardiovascular Controversies #1

Stents Versus Heart Bypass Surgery For Coronary Artery Disease

There was a time in America when you had a heart blockage that the only option available to you was heart bypass surgery. Over the last 50 years, cardiologists have been developing techniques in which a wire mesh tube is implanted in the blocked artery with an angioplasty balloon, providing another option for patients with blocked arteries. But the question remains is stent placement right for all patients and are the side effects of stents worthwhile?  The continued controversy over how severe coronary artery disease ( CAD ) is treated and whether the patients do better with stents or heart bypass surgery remains the question on the minds of many physicians and their patients.


Recent Scientific Study Comparing Stents and Heart Bypass Surgery

A recent study called “The Syntax Trial,” was conducted in 2009 with 1800 patients who were found to have severe Coronary Artery Disease. The basis of the study was to determine if the patients did better with stenting over heart bypass surgery.

  • Randomly selected patients with CAD were closely followed for a year after their procedures. Some patients had heart bypass surgery while others were implanted with drug eluting stents. The trial was designed to show that the results of stenting are at least as good as heart bypass surgery in patients suffering from severe Coronary Artery Disease ( CAD )
  • While the SYNTAX study sought to show that stenting was not inferior to bypass surgery it actually provided the exact opposite results. While randomized stented patients throughout the trial showed better than average outcomes in important aspects of the trial over heart bypass patients overall, the stented patients had 8% more complications (such as the formation of blood clots, artery narrowing, late stent thrombosis and death) than bypass patients.

While both procedures have a place in fighting heart attacks, the determination of which one is best for each individual patient remains controversial and it is a decision that should be made by a team of cardiologists and surgeons in consultation with the patient.  While significant advances have been made in stenting, heart bypass procedures remain the gold standard for complete revascularization, freedom from reintervention, and freedom from rehospitalization for angina (chest pain). There is no doubt that stent procedures have a much lower recovery time over heart bypass surgery but do they have the long-lasting effect of bypass surgeries?


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