Hospital Buyer

In light of new safety concerns over the long-term use of stents and emerging data indicating that the most complex heart patients, such as those with diabetes and multivessel disease, may live longer if they receive bypass surgery, some stent specialists say “the pendulum may have swung too far away from bypass surgery.”

In the last decade the number of bypass surgeries has decreased by about 30 percent while the number of patients receiving coronary stents was approximately one million in 2006. Dr. Kirk Garrett, from Lenox Hill Hospital in New York, one of the nation’s leading centers for stent procedures, states that “we as cardiologists have probably pressed forward on stent technology a little faster than we should have.” Some of the demand may have come from patients since compared to stent procedures, bypass surgery is considered a more invasive procedure with a lengthy recovery period. Also, the cardiologist decides whether to perform the stent procedure or to refer the patient for bypass surgery. Some cardiologists may choose not to consult with a heart surgeon. Furthermore, some surgeons may be unwilling to take on more complex cases due to state or hospital requirements for physician performance statistics.

According to Dr. Sidney C. Smith, Jr., committee head, new guidelines from the joint committee of the heart association and cardiology society will be available within the next month that will help clarify the boundaries between stenting and surgery. In addition, there are two major ongoing clinical trials that will directly compare stents and bypass surgery in more complex patients. The first trial, sponsored by Boston Scientific, will randomly assign 1500 patients to either surgery or stenting. The second trial, sponsored by the Department of Veterans Affairs, will compare stenting versus bypass surgery in patients with diabetes and severe coronary artery disease. The initial results for the first trial are expected next year, but long-term results from the second trial will not be available until 2012.

Related coverage: Drug-Coated Stents Not Always Best Option.

February 27, 2007 Related topics: Finance, Quality, Safety, Errors, Cardiology, Evaluation & assessment