Is a stent procedure or bypass surgery more effective for patients with severe heart disease?

This study compared the outcomes of stent versus artery bypass surgery for patients with severe heart disease. The authors concluded that both procedures improved survival, but patients with three-vessel heart disease benefitted more from artery bypass surgery.

Heart disease (HD) requires different treatment depending on the severity of the disease. Three-vessel heart disease is a severe type of HD where three arteries (a type of blood vessel) connected to the heart are blocked. Left main coronary artery disease is another severe type of HD, where the main artery of the heart is blocked.

There are two types of procedures frequently used to help treat severe HD. The first is a stent procedure, where a small tube called a stent is inserted into the blocked artery to widen it. The second is bypass surgery, where an artery is taken from somewhere else in the body to replace the blocked artery. It is not clear which procedure provides the most long-term benefit for patients with severe HD.

1800 patients with either three-vessel or left main coronary artery disease participated in this study.  Patients were divided into two groups. 903 patients had a stent procedure, and 897 patients had bypass surgery. Patients were followed-up for an average of 11.2 years.

Overall, all-cause mortality occurred in 27% of patients 10 years after the stent procedure. After bypass surgery, all-cause mortality occurred in 24% of patients. At follow-up, the stent procedure was associated with an 18% higher mortality risk compared to bypass surgery.

Among patients with left main coronary artery disease, survival rates 10 years later were similar between both procedures. After the stent procedure, all-cause mortality occurred in 26% of patients 10 years later compared to 28% of patients after bypass surgery.

Bypass surgery was more beneficial for patients with three-vessel heart disease after 10 years. After the stent procedure, all-cause mortality occurred in 28% of patients 10 years later compared to 21% after bypass surgery. Patients who had the stent procedure had a 41% higher mortality risk compared to patients who bypass surgery.

Diabetes status had no significant impact on survival after either procedure.

This study found that the survival of patients with severe heart disease was similar after receiving a stent procedure or bypass surgery. However, patients with three-vessel heart disease showed longer survival with bypass surgery.

This study received funding from Boston Scientific, the manufacturer of some equipment used for the procedures in this study. These results may be biased due to other health conditions, as most patients were age 65. Lastly, the types of stents used in this study are no longer available. Newer stent technology has improved patient outcomes.