Cardiac Bypass, Angioplasty and Stenting by Jeffrey Dach MD
No Reduction in Mortality or Heart Attacks
The following thirty nine medical studies compare invasive treatment with conservative treatment of coronary artery disease. Invasive treatment with bypass surgery, stent or angioplasty is compared with conservative treatment with drugs. These Thirty Nine Studies show that invasive treatment fails to reduce mortality or heart attacks, when compared to conservative medical treatment with drugs.
Brain Damage from Cardiac Bypass
Three studies in 1000 patients found that 50% of patients having bypass surgery have brain damage with permanent loss of memory and mental function.
Economic Benefits Make it Popular
Invasive treatment with bypass and angioplasty may not be the best treatment, yet is more likely to be offered because of the economic benefits.
Limited Cases see Reduced Mortality with Cardiac Bypass
Coronary Bypass has been found to prolong life in the limited number of cases who have both left main coronary disease and reduced ejection fraction. However, if Left Ventricular function is normal (i.e. normal ejection fraction), then bypass does not affect over all mortality compared to medical treatment.
Left Image Cardiac Bypass courtesy of Wikimedia Commons
Recent Stent Era Trials
Acute MI is a special case
Stenting after thrombolysis for acute Myocardial Infarction found to reduce mortality:
Schiller's study in Germany showed that immediate stenting after using clot busting drugs gave better mortality results when compared to delayed stenting. Three more recent stent-era trials have shown favorable reduction in mortality with stenting. However, this has not been consistently demonstrated.
However for multivessel coronary disease, no advantage over medical treatment seen with stenting.
Dr Richard Shemin writes in Circulation in 2008,"Survival advantages of stent therapy for coronary artery disease over medical therapy have not been a consistent result in clinical trials."
Compared to CABG, no advantage for stenting
A five year trial published in 2005 comparing stenting to CABG for multivessel disease shows no difference in mortality.
Medical Treatment for Heart Disease