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    Can Drug-Coated Stents Beat Bypass?

    3-Year Survival Similar for Drug-Coated Stent and Bypass, but Still Too Early to Tell

    Drug-Coated Stents vs. Bypass Surgery continued...

    Another study finding surprised Wilson. Because they don't require surgery, stent procedures are supposed to be much safer than bypass surgery. But the study showed that patients who got drug-coated stents had at least as many complications as bypass patients.

    "When we tried to tackle the tougher patients -- those with greater risk, like the typical patient sent to bypass surgery -- our complication rate went up," Wilson says. "We can no longer say we are safer with stents than with bypass at the time of procedure."

    Shah and Wilson agree that early stent complications are much more likely in patients with more advanced, more complicated disease. Shah says such complications are unlikely when doctors use stents as approved by the FDA.

    Researchers presented the study today at the American Heart Association's Arteriosclerosis, Thrombosis, and Vascular Biology Annual Conference in Chicago.

    Side Effects Compared

    Cholesterol plaque-laden arteries eventually narrow -- a life-threatening condition called atherosclerosis.

    Using a catheter inserted into an artery, interventional cardiologists push a balloon-like device into narrowed coronary arteries (the coronary arteries supply the heart muscle with blood). They then carefully inflate the balloon to widen the artery. After this process, called balloon angioplasty, stents may be used to keep the artery propped open.

    About a third of the time, bare-metal stents clog back up. Newer stents carry a drug coating that prevents clogging. But drug-coated stents have their own problems. The most serious one is that, once in a while, they cause a blood clot to form in the opened artery. This can lead to a fatal heart attack - sometimes years after the stent is put in.

    It's a rare event. But anyone who gets a drug-coated stent has to take powerful anticlotting drugs for at least a year. This means that bare-metal stents are still the best choice for some patients.

    "Time was, 90% of these patients got drug-coated stents. Now we're down to about 50% to 60%. That is a big drop," Shah says. "Some estimate the correct proportion should be 30% to 40% of stenting should be with drug-coated stents, and the rest with bare-metal stents."

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