Harvard Men's Health Watch

Stents and bypass equally effective for many cases of heart disease

In the Journals

A study published online Oct. 31, 2016, by The New England Journal of Medicine found that a minimally invasive procedure to implant a drug-coated stent in the heart is just as effective as bypass surgery for people with left main coronary artery disease (LMCAD). With LMCAD, the artery that supplies blood to most of the heart muscle is clogged with plaque.

In the study, 1,905 people with LMCAD and low or intermediate level blockages throughout the heart underwent either bypass surgery or a procedure to clear the blockage and implant a stent that releases a drug to prevent the blockage from recurring. The group was then followed for an average of three years. About 15% of people in both groups died or had a heart attack or stroke, which meant that the stents were equally effective as bypass surgery.

The researchers also reviewed the likelihood of complications within the first 30 days after surgery, when they are most common. They found stent patients had a 4.9% chance of death, stroke, or heart attack, compared with 7.9% of those who had bypass surgery. In addition, fewer stent patients had major bleeding, infections, kidney failure, or severe abnormal heart rhythms.

The researchers noted that bypass surgery should still be considered standard therapy for those with LMCAD and extensive blockages, but that stents are an acceptable, or perhaps even preferred, alternative for people who have LMCAD and low or intermediate level blockages.