HEART BYPASS SURGERY BETTER THAN STENTS?

THE STUDY:
THE SYNTAX STUDY reported in the LA Times, Sept 12, 2010, suggested that patients who got coronary stents were 28% more likely to suffer a heart attack, 46% more likely to need a repeat procedure, and 22% more likey to die than patients who had coronary bypass surgery (CABG). The study followed 1.800 patients in Europe or the United States who had a Taxus drug coated stent or underwent CABG.
The results were for those with severe diesase. What is severe disease? The heart has four major coronary arteries: the Left Main, the Left Anterior Descending, the Circumflex, and the Right Coronary Artery. The latter three can also have large branch arteries that may be big enough to require repair. These arteries can be repaired by bypass surgery, hence the possibility of double, triple, quadruple or even quintuple (five way) bypass grafts, or stents in as many arteries as needed. This study shows, and it has generally been known that usually the need for 3 arteries requiring fixing, tends to favor bypass surgery rather than stenting in 3 or 4 arteries.

THE BOTTOM LINE:
If you need one or two arteries fixed, and the arteries are of good size, meaning 2.5mm to 3mm or more in diameter, and the narrowed segment in the artery is short, stents are preferable in most cases to coronary bypass surgery, in my opinion. Drug coated or so called drug eluting stents (DES) have been the most significant advance in treating advanced coronary artery disease (blockages). When I first starting performing coronary balloon angioplasty (PTCA) in 1984, there was a 30% chance or more that the artery would renarrow in 6 months. Now with drug eluting stents (DES), less than 5% will narrow, and if so it is in one year. After one year then stent has <1% chance of narrowing. With bypass surgery, each graft deteriorates over time at about 4% per year risk of closing, so by 10 years about 60% of grafts are closed or closing and probably a repeat bypass surgery is needed.