Coronary Bypass Better than Stents for People with Multiple Artery Blockages

The study from West Virginia University researchers found that coronary bypass surgery had a better overall outcome for people with multiple blockages than stenting procedures.

Coronary artery disease (CAD) results from atherosclerosis or hardening of the arteries that reside on the surface of the heart. Atherosclerosis happens when plaques or fatty deposits build up on the inside walls of the arteries. As the buildup increases, it can cause a reduction in blood flow to the heart muscle.

Treatments for CAD can include placing wire mesh tubes called stents into the blocked arteries. This procedure is relatively low risk because it is not major surgery. In contrast, coronary artery bypass grafting (CABG) requires an incision on the chest so the surgeon can use healthy vessels from other areas of the body to reroute or bypass the blocked artery in the heart.

Cardiologists decide which procedure is appropriate based on several factors. One of those factors is whether the person with CAD has multiple blockages.

Now, new research from scientists at the Department of Cardiovascular and Thoracic Surgery at West Virginia University has found that coronary artery bypass surgery may be the better choice for people with blockages in multiple arteries.

The results of the investigation — Contemporary Artery Bypass Grafting versus Multivessel Percutaneous Coronary Intervention in 100,000 Matched Medicare Beneficiaries — were presented on January 22 at the annual meeting of The Society of Thoracic Surgeons in San Diego.

The multidisciplinary team, including cardiac surgeons, cardiologists, and researchers at West Virginia University, analyzed data from more than 100,000 people with multivessel coronary disease. They included 51,000 patients undergoing CABG surgery and 52,000 undergoing stenting.

Their analysis revealed a significantly lower hospital mortality rate for people who had CABG surgery compared to those who had stenting procedures. The team also found that CABG surgery was associated with a significant reduction of 30-day and three year hospital readmissions for myocardial infarction.

Moreover, people who underwent CABG surgery were also significantly less likely to require additional stenting or other interventions on their coronary arteries during those three years. The team also found that three years post-operation, those who had CABG surgery had an almost 60% reduction in mortality compared to those who had stenting.

The study authors suggest that people with multiple artery blockages who undergo CABG are less likely to die from their condition, less apt to need additional surgery, and less prone to having a heart attack than individuals who choose a stenting procedure.

In a news release, J. Hunter Mehaffey MD, MSc, from the Department of Cardiovascular and Thoracic Surgery at West Virginia University, said:

“The findings of our study were very convincing. The singular message to the public is that the optimal treatment for multivessel coronary artery disease — to improve not only long-term survival but also lower your risk of complications — is coronary artery bypass surgery.”