Stents are less invasive, less expensive and have about the same overall mortality rate as bypass surgery — so why would anyone choose the latter option? Well, because it may make the difference between life and death, according to recent research that provided some very interesting and helpful insights.
A comparative analysis of the survival rates of coronary bypass versus stenting was recently published in The Lancet. The study looked at the outcomes of more than 7,800 patients and confirmed once again that overall mortality rates between the two treatment options are quite similar. However, two specific types of people — patients over age 65 and those with diabetes — did far better with coronary bypass than with stenting. In fact, those with diabetes saw a 30% increase in the chance of long-term survival with bypass, and those age 65 and older saw an increase of 18%.
To find out why, I contacted Harlan M. Krumholz, MD, professor of medicine and epidemiology and public health (cardiology) at the Yale University School of Medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation. He said there’s no official answer to that question, but was willing to offer an educated guess. “It may just be that [these groups] have more extensive disease and the angioplasty isn’t really addressing it,” he said. “Surgery usually involves a complete revascularization, where everything is bypassed — it may be that the result is a better blood flow to the heart.”
Obviously, this study provides some important clinical information that should help doctors and patients make better decisions. The right choice isn’t always the obvious one. In medicine, there is no such thing as “one size fits all.”
