For Multiple Heart Blockages, Bypass Surgery or Stents?
Study Compares Pain, Quality of Life After Drug-Coated Stents or Coronary Artery Bypass Surgery
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Comparing the Effectiveness of Stents vs. Bypass continued...
In CABG, surgeons typically saw through the breast bone and open the rib cage, a procedure that, in and of itself, requires significant downtime for recovery. Doctors usually also need to make incisions in other parts of the body, often the legs, to harvest healthy vessels that can be used to bypass blockages.
In PCI, a catheter is threaded through an artery in the groin up to the heart, where a doctor uses a video monitor and radioactive dye to locate the blockages within arteries. The doctor then inflates a balloon to compress the buildup against the artery walls and places a stent to hold the spot open.
The stents in this trial were coated with the drug paclitaxel, which is thought to help prevent the formation of scar tissue around the site of stent implantation, a problem called restenosis.
Before any procedure was performed, an interventional cardiologist and a cardiac surgeon consulted together on each case. If there was mutual agreement that the blocked vessels might be effectively opened using either procedure, the patient was cleared to enter the study.
Before patients were assigned to one procedure or the other, doctors asked patients questions about how often and how strongly they’d been feeling angina, or chest pain, their physical limitations and general quality of life. Based upon the answers, patients were scored on a scale of 1 to 100, with higher scores indicating fewer symptoms and better health status.
Those questions were asked again one month, six months, and 12 months after their procedures.
A disease severity score was also determined at study entry for each patient. This score is dependent upon the degree and extent of blockages as demonstrated on the initial angiogram, with higher scores indicating more complex disease. For subsequent analysis purposes, the patients in the study were divided into three subgroups depending upon their disease severity scores (0 to 22, 23 to 32, and 33 to 83).
In all, 903 patients received stents, while 897 had bypass surgery. In both cases, doctors tried to open all the arteries that were at least 50% blocked.