Two leading cardiac surgeons opined that invasive cardiologists were implanting stents indiscriminately in heart patients with multiple blocks and quoted recent studies to claim that the outcomes were better with bypass surgery.
Talking to The Hindu , the experts, who did not wish to be identified, cited the findings of three latest scientific trials which showed the superiority of bypass surgery over the use of angioplasty stents in heart patients. Besides, bypass surgery was cost-effective as it would be in the range of Rs. 1.5 lakh as against Rs. 4 lakh to 5 lakh for implanting stents.
In ASCERT trial conducted in the United States, as many as 1.89 lakh patients, who either underwent bypass surgery or stenting due to multi-vessel coronary artery disease, were studied. It was found that those who underwent bypass had 51 per cent less possibility of getting a fresh heart attack as compared to those who were implanted stents.
Also, the bypass surgery patients had 21 per cent survival advantage after four years. Two other studies—Freedom Trial and Syntax Trial—also showed similar findings, they said.
When patients visit cardiologists with chest pain or angina, they are recommend stents, irrespective of the fact that the outcome would be better with bypass surgery. Based on limited information and due to inherent psychological fear against surgery, the patients too opt for stents, the two experts said. “Patients with multiple blocks and diabetics should seek bypass surgery instead of stents. There was a need to create awareness on this aspect,” they added.
When treating multiple blocks, there were instances of implanting stents for one block, while giving medicines to clear others. This should not be accepted by the patients.
All blocks should be cleared either by stenting or through bypass surgery as residual blocks would later lead to heart attacks.
In a bid to avoid indiscriminate use of stents, one of the experts suggested that as in Europe a cardiac team, comprising cardiologists and surgeons, should evaluate and decide the best option. He said stenting and bypass surgery were not competitive but complementary and it would be better to have cardiac teams in place. He said that resorting to ad hoc stenting was almost stopped in the United States where surgeries have increased by 80,000 last year.
In United Kingdom, the approval of surgeons is required under the National Health Services if more than two stents are to be implanted. A similar practice is being implemented in Arogyasri cases here.
