For the hundreds of thousands of people every year that are told they have blocked arteries, the choice does not involve whether or not to have something done. If the patient doesn't undergo one of the two types of procedures, CABG surgery (coronary artery bypass grafting surgery) or stenting, the great likelihood is that they will die.



Stenting was hailed as a groundbreaking treatment when it first came onto the mainstream, with the need for open heart cardiac bypass surgery at hospital heart centers removed, much shorter recovery times and lower perceived risks. However, a study has found that for patients with severe blockages or those in tricky spots, the traditional CABG may be the preferred option.

The study on CABG surgery versus drug coated stenting measured several main factors - the rate of death, stroke and heart attack in treated patients, and the need for them to have a repeat cardiac surgery procedure at a hospital heart center. For bypass surgery patients, the rate of death stroke and heart attack combined was 7.7 percent, compared to a nearly identical 7.6% for stent patients. However, stented patients were more than twice as likely to need a repeat procedure within the year.

The 1800 patient, one-year study focused on patients with three-vessel or left-main disease. These are basically blockages in either three of the four main vessels of the heart, or the left main artery respectively. It was completed by Dutch researchers, and the comparison with CABG surgery was done with the newer type of drug-coated stents.

Researchers at the Mayo Clinic in the United States generally agreed with the findings, as do doctors at cardiac hospitals in Thailand, which affordably treat thousands of patients with cardiac bypass surgery in Thailand every year. Ray Gibbons, of the Mayo Clinic said; "In somebody with three-vessel or left-main disease, in most cases surgery is the preferred therapy and this trial does not change my view of that".

Stenting was introduced in the 1990s, and after an initial period where cardiac hospitals in Thailand, the US and Europe were apprehensive about the new technology, many surgeons have assumed them to be the equivalent of each other. If the result for stenting had been more favourable, it could have encouraged doctors to recommend the procedure in more cases.

However, the study shows that there is still a need to weigh the risks of needing a repeat procedure against the convenience of stenting.

However, stenting should remain quite a popular procedure. Despite the fact that more than twice as many patients experienced revascularization and needed further cardiac surgery, this only represented an extra 5% of people.

Medical professionals also found it reassuring that the main safety concerns in cardiac surgery were the same for either procedure. "The primary endpoint was missed. But it wasn't missed because of safety concerns; it was missed due to revascularisation," said Keith Dawkins, Associate Chief Medical Officer at Boston Scientific.