Are stents or bypass surgery more effective in preventing a future heart attack? That question often confronts patients with severely clogged heart arteries, and a study published Monday in JAMA Internal Medicine tips the balance clearly in favor of bypass surgery as the more effective route to prevent a future heart attack or heart disease death.
Another study published in the same journal finds that getting a stent in addition to taking medication is no better than drug therapy alone for preventing heart attacks and death in those with a single clogged artery.
The two studies combined data from previous clinical trials to reach their conclusions. The first looked at six trials involving more than 6,000 heart disease patients with multiple clogged arteries who were randomly assigned to have bypass surgery—where diseased portions of the heart arteries are replaced with transplanted vein or artery grafts—or a less invasive stent placement to prop open a clogged artery. Those who had the bypass were 27 percent less likely to die over the four-year study and 42 percent less likely to have a heart attack than those who had the stents.
In the second study, researchers examined data from five trials involving more than 5,000 heart patients with a single clogged artery. They found no difference in heart attack rates or deaths in patients who had a stent procedure while also taking drugs like statins, compared to those who just used medications.
These two trials only involved patients with stable heart disease—not those having a heart attack or life-threatening chest pain who were treated during emergencies. For those emergency patients, stent placements can still be lifesaving, said Dr. Valentin Fuster, director of the Mt. Sinai Heart Center in New York and past president of the American Heart Association.
But those with chronic heart disease who have clogged arteries should understand that getting stents to open their artery clogs in a non-emergency situation won’t likely provide any lifesaving benefits or prevent future heart attacks. Those with multiple clogged arteries will likely do better with bypass, Fuster said, while those with a single clogged vessel can probably skip the stent placement, unless they’re getting one to relieve symptoms like chest pain.
“I’ve seen a recent change in practice at my institution and elsewhere,” said Fuster, who published research last year showing that bypass yields better outcomes than stents for diabetic patients. “We’re seeing more bypass procedures, more medical therapy, and less use of stents.”