Stents vs. bypass – a 10 year follow-up in patients with coronary heart disease

This study investigated the long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to treat coronary heart disease (CHD). They found that CABG was associated with a longer-term benefit than PCI.

Coronary heart disease (CHD) is caused by blockages to the vessels supplying blood to the heart. CHD can be treated using medication or surgery. Two types of surgical procedures are commonly used to restore blood flow. Coronary artery bypass grafting (CABG) involves using a healthy vein to bypass the blocked arteries. Percutaneous coronary intervention (PCI) is a procedure that uses medical devices called stents to remove the blockage and restore blood flow. Some of these stents contain drugs and are called drug-eluting stents (DES).

Both of these procedures are usually successful in restoring blood flow. It is important to restore blood flow long term. Target vessel revascularization (TVR) is the procedure to correct or repeat a surgical procedure. It is unclear if CABG or PCI is more effective at restoring blood flow long-term.

This study included 2,240 patients with CHD affecting the left artery. The authors analyzed data from patients that had either CABG or PCI. Most of the patients were followed-up between 10.7 and 13.5 years. The risk of dying and other important factors relating to CHD were analyzed. One of these was the risk of TVR.

Up to 5 years of follow-up, the risk of death was similar in patients that underwent CABG or PCI. TVR risk was significantly higher in patients that underwent PCI vs. CABG. After 5 years, the risk of death was 35% higher in patients that had a DES. The risk of CHD-related events such as heart attack or stroke was 46% higher in patients who had a PCI (DES) after 5 years.

The authors concluded that the risk of death after 5 years was lower in patients that had CABG compared to PCI.

There may have been other factors influencing survival e.g. medication. More research is needed to confirm the findings.

If you have any concerns regarding CHD treatment, please consult with your doctor.