PMs surgeons get it right,study backs bypass surgery

The authors in a multicentric study involving 1800 patients said that stenting or the insertion of tiny metal scaffolds which is coated with a compound designed to prevent blood clots from forming in order to keep the arteries open needs additional treatment and leads to more adverse effects . However,the two groups had similar risks for deaths and heart attack.

The 1,800 patients were treated at 85 medical centers in the United States and in Europe,and all had severe,untreated,three-vessel disease or left main coronary artery disease. Patients were randomly assigned to undergo either CABG or stenting,and then monitored for adverse effects including death,strokes,heart attacks or repeat revascularisation procedures.

Over all,the stent patients had a higher risk of adverse outcomes,with 17.8 per cent suffering an adverse outcome,compared with 12.4 per cent for CABG patients. CABG patients were however,more likely to have strokes,with 2.2 per cent suffering a stroke compared with 0.6 per cent of stent patients.

Stent patients were more likely to need repeat procedures,the researchers found. Some 13.5 per cent needed repeat revascularisation,compared with 5.9 per cent of bypass patients.

On balance,CABG was adjudged a better treatment because the guidelines of the clinical trial called for evaluating the risk of all adverse events combined. But some experts questioned whether an increased risk for an additional procedure,associated with stenting,should carry the same weight as the increased risk of stroke,associated with CABG.

However,the study suffers from certain limitations namely,the participants were primarily men who were tracked for merely a year. The study has led to an international debate between proponents of both procedures over the trial findings after it was first revealed in a cargiology congress in Europe in October 2008. Both sides claimed partial victory from the study.