Stent or Bypass? How can we protect ourselves from Heart Attack?
There are metal “tubes” that are placed inside the heart artery by opening the blockage of the artery, and there are both medicated and non-medicated ones. They are inserted into the vein inside the heart by entering from the groin or arm. Bypass surgery is a treatment performed by creating a bridge over the blockages with veins taken from various parts of the body. Here are the results of both treatments compared in one of the world’s leading journals. New England Journal of Medicine
What is a stent?
There are medicated and non-medicated versions of the metal “tubes” that are placed inside the coronary artery to unblock the artery.
How is a stent applied?
It is inserted into the vein inside the heart by entering through the groin or arm. There is usually no need for the patient to receive anesthesia during the procedure. Watch the animation from Mayo Clinic ( (click)
Stent advantage / disadvantage
It is a simpler procedure to insert than bypass surgery and the rate of paralysis is lower than with bypass. However, the rate of blockage is higher than with bypass, even with medication.
Bypass
A vein removed from anywhere in the body is stitched to the vein in the heart, bridging the narrow area.
It requires general anesthesia and intensive care monitoring. In many cases, the chest is opened and the heart is stopped by connecting it to a machine.
The risk of blockage after bypass is less than with stents. The rate of heart attack after the procedure is lower. However, the rate of stroke is higher than with stent placement.
The question that concerns many cardiovascular patients is answered by a comprehensive scientific study.
A total of 3075 patients in 17 European countries and the United States were compared with each other for the treatment of blockage in the heart arteries with drug-assisted stents and heart bypass surgery. One-third of the patients were separated at the beginning of the study and were found suitable only for bypass surgery and no stent was placed. Of the remaining approximately 1800 patients, 900 received stents and the other 900 received bypass surgery. Care was taken to ensure that this selection was random and the patients’ consent was obtained.
Early Results
The mortality rates before hospital discharge were evaluated as almost similar in drug-eluting stents (4.4%) and bypass surgery (3.5%). However, the risk of stroke after bypass surgery (2.2%) was found to be significantly different (approximately 3.5 times) compared to the risk of stroke after stents (0.6%). The most important reason for this result was shown to be the use of the Heart-Lung Machine, especially in classical open-heart surgery.
After 1 year and 5 years?
The patients were followed up for a total of 5 years. The results of the first 3 years were evaluated. According to these results, the rates of death, stroke or heart attack (12%) in patients who had bypass surgery were lower in the first two years compared to those who had drug-eluting stents (18%). Especially people with impaired vascular structure or diffuse stenosis and occlusions in all three of their vessels and patients with diabetes benefited more from bypass surgery. While the mortality rate was (8%) in people with impaired vascular structure who had drug-eluting stents, it was determined as 2.6% in those who had bypass surgery. In addition, in such patients, 17.2% of those who had undergone bypass surgery or stent placement within the first year after treatment with drug-eluting stent required a second treatment, while only 5% of those who had bypass surgery required a second treatment.
This study, conducted by the best cardiologists and surgeons in Europe, has emphasized once again that when making a decision for a patient, the cardiologist and the heart surgeon must work together. Patients with poor vascular structure and multiple vessel involvement benefit from bypass surgery, while simple and mild stenosis can be easily opened with a stent.
As a result, it was revealed that 76% of the patients included in this study would benefit more from bypass surgery. While nearly 18% of the patients had the chance to be treated with both drug-eluting stents and bypass, it was noted that 6% could get the best result with stents. When the long-term results are evaluated, we will all see the results together.
New England J Madecine, 3/200