Stent can sub for some heart bypass

Feb. 24, 2006 at 1:04 PM
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WASHINGTON, Feb. 24 (UPI) -- Drug-eluting coronary stents can be a less invasive alternative to cardiac bypass surgery in some cases, says a new study.

The study, done at Cedars-Sinai Medical Center, showed that angioplasty with coronary drug-coated stenting may be a viable substitute to the more complex heart bypass in patients with left main coronary artery disease.

The somewhat rare condition -- affecting about 5 percent to 7 percent of patients who undergo angiography -- has earned the nickname "widow maker" due to its risk of sudden death.

The Cedars-Sinai research involved 123 patients who underwent bypass surgery and 50 who were treated medically with angioplasty and the drug-releasing stents, none of whom had had previous bypass surgery.

Forty-six percent of the bypass-surgery group was considered high-risk patients, compared to 64 percent in the group treated with drug-eluting stents.

"Despite the greater percentage of high risk patients in the group who underwent coronary stenting, there was no increase in the immediate or medium-term complications compared with the group treated with bypass surgery," said Raj Makkar, director of the Interventional Cardiology and Cardiac Catheterization Laboratory at Cedars-Sinai, who led the study.

Patients who had bypass surgery had longer hospital stays and, after one month, a higher percentage of strokes, but there was no significant difference in death or myocardial infarction, the study authors said.

Six months after treatment, there had been seven deaths in the bypass-surgery group and two in the group treated medically, they noted.

Makkar said the trial is among the first in the United States to focus on the use of medicated stents for the treatment of LMCA disease.

In the past, The American College of Cardiology and the American Heart Association have discouraged the medical treatment of LMCA disease due to poor clinical outcomes, the researchers said.

However, they added that, in light of their study results and the recent success with drug-eluting stents, the procedure's use in treating LMCA deserves a second look.

"The most important finding in this study is that, in a pilot experience (in LMCA patients with no prior bypass surgery), treatment with drug-eluting stents resulted in outcomes at least equivalent to bypass surgery ," said P. K. Shah, director of the Division of Cardiology at Cedars-Sinai.

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