Diabetics with more than one diseased artery fared significantly better
if they underwent bypass surgery than those who received drug coated stents
following artery clearing procedures to improve blood flow to the heart,
according to data from a five-year study presented on Sunday.
After five years, the bypass group had a lower combined rate of heart
attacks, strokes and deaths of 18.7 percent versus 26.6 percent for the stent
group in the 1,900-patient study funded by the U.S. National Institutes of
Health. The result was deemed to be highly statistically significant,
researchers said.
Previous studies had demonstrated the superiority of bypass surgery over
the use of bare metal stents - tiny mesh tubes used to prop open cleared
arteries. Researchers suspected that newer stents coated with drugs to prevent
reclogging might negate some of the bypass advantage, but that turned out not
to be the case. "The advantages were striking in this trial and could
change treatment recommendations for thousands of individuals with diabetes and
heart disease," said Dr. Valentin Fuster, from Mount Sinai School of
Medicine in New York, who presented the findings at the American Heart
Association scientific meeting in Los Angeles.
There was a higher incidence of stroke in bypass patients -- 5.2 percent
versus 2.4 percent. Stroke is a known risk of the surgical procedure in which a
piece of a healthy blood vessel from another part of the body is grafted on to
re-route blood flow around a blocked heart artery. But deaths from any cause
were significantly lower with bypass surgery than those who received artery
clearing angioplasty and a drug eluting stent - 10.9 percent compared with 16.3
percent. There were also twice as many heart attacks among diabetics in the
stent group within five years - 99 vs 48, which Fuster called "very
significant."
More than one million bypass surgeries or stenting procedures are
performed in the United States each year and some 25 to 30 percent of those
involve diabetics with multiple diseased arteries, researchers said. If the
results of this study alter clinical practice, it could eat into lucrative
profits of the companies that sell drug coated stents, such as Abbott
Laboratories, Boston Scientific Corp and Medtronic Inc. Boston Scientific and
Johnson & Johnson supplied the stents used in the study, but J&J has
since exited the stent business.
Dr. David Williams of Brigham and Women's Hospital in Boston, who was
not involved in the study, called the results "very convincing." "I
think the (treatment) guidelines will recognize this and I do think it will be
adopted," he said. However, Fuster cautioned that longer term follow-up of
patients was necessary. "We always want to know how long the effects
last," he said. "The gap could begin to close or the results could
get better and better."
Source: Chicago Tribune
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