Stenting and Bypass Surgery Offer Same Protection

A multisite international study has demonstrated that, after one year, angioplasty with coronary-artery stenting offers the same protection against stroke, heart attack, and death as bypass surgery. Although stenting costs less, it results in the need for a second revascularization more often than bypass surgery. The study, conducted by the Arterial Revascularization Therapies Study Group under the auspices of the European Academy of Sciences and Arts, was published in The New England Journal of Medicine (2001;344;1117-1124).

The study involved 1,205 patients, randomly assigned to have the stent procedure or bypass surgery when a cardiac surgeon and an interventional cardiologist agreed that either procedure would produce the same amount of revascularization. Among patients in the stenting group who survived without a stroke or heart attack, 16.8% needed to have a second revascularization, compared to only 3.5% of patients in the surgery group. After one year, 73.8% of stent patients and 87.8% of surgery patients had an event-free survival. Stenting was estimated to cost about US$3,000 less than surgery.

Because angioplasty with stenting is less invasive than surgery, it is associated with a faster recovery and better quality of life one month later. On the other hand, bypass surgery is associated with a lower incidence of angina in the first year and fewer interventions. The researchers note that doctor and patient need to weigh all these factors in deciding which approach is best.