Bypasses are better than stents

http://www.msnbc.msn.com/id/22806798/

Bypasses are better for multiple blockages. This study dims hopes that the simpler procedure will work instead of bypass surgery.

I told myself not to read this, now I'm terrified! My husband has had six (6) stents put in, in the last 8 years. I was aware that he had heart condition when we married 2 years ago. He sees his cardiologist on a regular basis, he has appointment coming up next week. I'm going to print this article out and ask his Dr. about it. I lost my first husband in 1997 from a massive heart attack.

paddy01 said:

I told myself not to read this, now I'm terrified! My husband has had six (6) stents put in, in the last 8 years. I was aware that he had heart condition when we married 2 years ago. He sees his cardiologist on a regular basis, he has appointment coming up next week. I'm going to print this article out and ask his Dr. about it. I lost my first husband in 1997 from a massive heart attack.

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Please do not be alarmed about this. Every heart patient is a special case. Your husband may have been a perfect candidate for the stent procedure. I urge you to talk with your husbands cardiologist in order to ease your fears.

The study looked at what were the statistical rates of major complications (heart attacks etc.) within the first 30 days following a procedure and then for 3 years after the initial 30 days. 5% were seen in drug-eluting stents vs 3.8% in bypass. These numbers may look different but statistically speaking it is the same value.

The study also compared bare metal stents versus the newer drug-eluding stents. The higher rate of complications with the drug-eluting stents were more because of the patient selection process and not because of faulty technology. When the drug-eluding stents were new physicians were reluctant to use them on really sick patients, preferring to use the gold standard of bare-metal stents and even bypass instead of risk a new procedure.

In terms of DE stents versus BM in comparison to bypass in the arena of survival there was no significant difference statistically between the two. The reported death rate 3 years following bypass was 6.6% versus 9% after DE stent.

This study has to be approached in the right manner. Essentially what the article is saying is that the risk of bypass surgery and DE stents are the same in patients that are considered high risk. Doctors choose patients that they feel will do better with the stents then they choose that therapy. If they feel like the procedure will not benefit the patient they will go with bypass.

I hope this eases your mind a bit.
Chloe

My mom has two stents... I wont even mention this to her.. She is freaked out enough as it is...
One good thing came from her heart attack this past summer - she has quit smoking and lost over 45lbs. She eats healthy (fish, chicken and veggies are her main dishes) and she really reads labels now regarding sodium and cholesteral...

Chloekins said:

Please do not be alarmed about this. Every heart patient is a special case. Your husband may have been a perfect candidate for the stent procedure. I urge you to talk with your husbands cardiologist in order to ease your fears.

The study looked at what were the statistical rates of major complications (heart attacks etc.) within the first 30 days following a procedure and then for 3 years after the initial 30 days. 5% were seen in drug-eluting stents vs 3.8% in bypass. These numbers may look different but statistically speaking it is the same value.

The study also compared bare metal stents versus the newer drug-eluding stents. The higher rate of complications with the drug-eluting stents were more because of the patient selection process and not because of faulty technology. When the drug-eluding stents were new physicians were reluctant to use them on really sick patients, preferring to use the gold standard of bare-metal stents and even bypass instead of risk a new procedure.

In terms of DE stents versus BM in comparison to bypass in the arena of survival there was no significant difference statistically between the two. The reported death rate 3 years following bypass was 6.6% versus 9% after DE stent.

This study has to be approached in the right manner. Essentially what the article is saying is that the risk of bypass surgery and DE stents are the same in patients that are considered high risk. Doctors choose patients that they feel will do better with the stents then they choose that therapy. If they feel like the procedure will not benefit the patient they will go with bypass.

I hope this eases your mind a bit.
Chloe

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Thank you Chloe, yes after reading this I do feel better. I showed the article to my husband and he said we'll speak to his doctor next week just to be on the safe side. I do appreciate you posting this for me.
Paddy

Chloekins said:

Please do not be alarmed about this. Every heart patient is a special case. Your husband may have been a perfect candidate for the stent procedure. I urge you to talk with your husbands cardiologist in order to ease your fears.

The study looked at what were the statistical rates of major complications (heart attacks etc.) within the first 30 days following a procedure and then for 3 years after the initial 30 days. 5% were seen in drug-eluting stents vs 3.8% in bypass. These numbers may look different but statistically speaking it is the same value.

The study also compared bare metal stents versus the newer drug-eluding stents. The higher rate of complications with the drug-eluting stents were more because of the patient selection process and not because of faulty technology. When the drug-eluding stents were new physicians were reluctant to use them on really sick patients, preferring to use the gold standard of bare-metal stents and even bypass instead of risk a new procedure.

In terms of DE stents versus BM in comparison to bypass in the arena of survival there was no significant difference statistically between the two. The reported death rate 3 years following bypass was 6.6% versus 9% after DE stent.

This study has to be approached in the right manner. Essentially what the article is saying is that the risk of bypass surgery and DE stents are the same in patients that are considered high risk. Doctors choose patients that they feel will do better with the stents then they choose that therapy. If they feel like the procedure will not benefit the patient they will go with bypass.

I hope this eases your mind a bit.
Chloe

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thank you- my dh has 3 stents, and like paddy, I was afraid to read the article
ok- I just went and read it--- this I dont understand--- do these % work for anyone else?

taken from article
People with three clogged arteries had a survival rate of 94 percent after bypass compared with about 93 percent after stenting, which translated to a 20 percent lower risk of death. Those with two blockages had a survival rate of 96 percent after the operation compared with roughly 95 percent after stenting — about a 30 percent lower risk of death. The bypass group also needed fewer repeat procedures and suffered fewer heart attacks after treatment.
???

lisag said:

My mom has two stents... I wont even mention this to her.. She is freaked out enough as it is...
One good thing came from her heart attack this past summer - she has quit smoking and lost over 45lbs. She eats healthy (fish, chicken and veggies are her main dishes) and she really reads labels now regarding sodium and cholesteral...

Click to expand...

--My mother has two stents also--She got them last June--She didn't have a heart attack but they found 2 arteries 99% blocked--but unlike your mother, my mother did NOT quit smoking, she still does not eat healthy, and she still won't look at labels--My mother needs some of your mother's common sense--btw my mother is 78, what's your mother's age?

Well, SORRY FOLKS!!! I surely didn't bring this subject up to distress anyone.

Looking closely, it seems like both drug-coated stents and bypass surgery can each have excellent results. Looks like the new stents much better than the older ones.

And the success depends on, is it right for you - your age, medical condition, etc.

It looks to me like the difference is in long term survival rates; but I'm not sure. Those statistics are difficult to understand.

I think: Survival rate means - surviving surgery Death rate is anytime in the future.

For some reason a 1% lowered survival rate translates into a higher death rate at any time in the future.

Please correct me if I'm wrong, any doctors or researchers on here.

j2mirish said:

thank you- my dh has 3 stents, and like paddy, I was afraid to read the article
ok- I just went and read it--- this I dont understand--- do these % work for anyone else?

taken from article
People with three clogged arteries had a survival rate of 94 percent after bypass compared with about 93 percent after stenting, which translated to a 20 percent lower risk of death. Those with two blockages had a survival rate of 96 percent after the operation compared with roughly 95 percent after stenting — about a 30 percent lower risk of death. The bypass group also needed fewer repeat procedures and suffered fewer heart attacks after treatment.
???

Click to expand...

This is mostly scare techniques and people who obviously know very little about the actual study that was done.The purpose of the study was to see whether or not the stent worked as well as former procedures. The result was that there was no difference. Bypass surgery was as good as and had the same results as the stents.

I will try to explain it in a way that most people understand and I find helps me. Think of 94% as 94 people out of 100 and 93% as 93 out of 100. This means that after stenting 1 person out of 100 had problems. Im not exactly sure how they did their math because last time I checked 1% increase translates into exactly that 1% or 1 out of 100. Perhaps they are taking a derivative of all procedures done. We have to keep in mind that the levels of narrowing due to plaque range from moderate to severe. Other factors include the position of the blockage, the overall architecture of the heart, and how the vessels lie within the person's heart (not all people's vessels lie the same way). Keep in mind that not all of a vessel can be replaced, only portions. Those that need entire vessels replaced undergo bypass not stents. Since they are more than likely taking all procedures done over the course of a set period of time, they are factoring all levels of severity. This is why I say it is a negligible increase that doesn't translate really into people. If I am 60 years old and have almost total occlusion of 6 vessels my outcome is more risky than say a 48 year old having partial occlusions in 2 vessels. To lump all patients together regardless of severity levels is probably where they got their numbers.

To address the issue of bypass recipents needing fewer repeat procedures makes sense. People who undergo bypass surgery are beyond the point where a stent will help them. They need a total bypass of that or those particular vessels. If all your occuled vessels are bypassed and you follow your doctors diet instructions you shouldnt need to have another procedure. Some people naturally produce gobs and gobs of plaque that has nothing to do with diet. These people sometimes need additional bypass surgeries, however this is a rare occurance. If you do not follow instructions per your doctor, exercise, diet etc. you increase your risks of repeat surgeries.

As far as the statement of people undergoing stents vs bypass having more heart attacks following the procedure reflects that same thought process. If someone can be treated with the stent procedure vs bypass the physician is going to go that route. Even if it takes 6 or 7 stents that is preferable to open heart surgery. Many factors reflect whether or not someone can risk major surgery. If your doctor feels like bypass would be more detrimental then multiple stents he/she is going to go that route. If he/she choses that avenue and inserts the stents you are still going to have possible occlusion occurring in areas where a stent has not been placed. Bypass surgery is major surgery requiring 8-14 hrs and at least a week recovery period in the hospital compared to a 1-4 hour procedure that requires only an overnight stay.

I always do a few things when I read a health report in a general news article. First I look up the article to which they are referring. If it is a good news source they will provide it. Then I read the study. Next I try to determine who funded the study. This often times influences certain outcomes of research, it shouldnt happen but it does. Nine times out of 10 the journalists are trying to get a good story out of something where there is none.

It seems like some of the things said in the article are misleading, or alarmist.

Marthatex said:

Well, SORRY FOLKS!!! I surely didn't bring this subject up to distress anyone.

Looking closely, it seems like both drug-coated stents and bypass surgery can each have excellent results. Looks like the new stents much better than the older ones.

And the success depends on, is it right for you - your age, medical condition, etc.

It looks to me like the difference is in long term survival rates; but I'm not sure. Those statistics are difficult to understand.

I think: Survival rate means - surviving surgery Death rate is anytime in the future.

For some reason a 1% lowered survival rate translates into a higher death rate at any time in the future.

Please correct me if I'm wrong, any doctors or researchers on here.

Click to expand...

Marthatex, I'm very glad that you posted this information, we need to be informed. I thank you. I will indeed check this out further with husbands cardiologist.

Marthatex said:

It seems like some of the things said in the article are misleading, or alarmist.

Click to expand...

Yes very much so. When I was doing my internship I would have people hysterical bringing in articles printed off the internet concerning something they were convinced was being done incorrectly. While I find that an informed patient is a blessing (because I have to explain things less), it is important that the information obtained is viable. The scarier something sounds the more likely one is to read the article. I like to keep in mind that for the most part your physician has been trained and educated to a higher degree than almost all of the people who write these articles. Different language is used between peers. We interpret things differently and use different words among ourselves that we wouldn't use with patients. Sometimes the way things are worded become frightening to those who aren't used to reading medical journal articles. We read them and think, "Bah not enough evidence, Im not buying it" where the average person immediately panics whilst reading the same exact thing.

Chloekins said:

This is mostly scare techniques and people who obviously know very little about the actual study that was done.The purpose of the study was to see whether or not the stent worked as well as former procedures. The result was that there was no difference. Bypass surgery was as good as and had the same results as the stents.

I will try to explain it in a way that most people understand and I find helps me. Think of 94% as 94 people out of 100 and 93% as 93 out of 100. This means that after stenting 1 person out of 100 had problems. Im not exactly sure how they did their math because last time I checked 1% increase translates into exactly that 1% or 1 out of 100. Perhaps they are taking a derivative of all procedures done. We have to keep in mind that the levels of narrowing due to plaque range from moderate to severe. Other factors include the position of the blockage, the overall architecture of the heart, and how the vessels lie within the person's heart (not all people's vessels lie the same way). Keep in mind that not all of a vessel can be replaced, only portions. Those that need entire vessels replaced undergo bypass not stents. Since they are more than likely taking all procedures done over the course of a set period of time, they are factoring all levels of severity. This is why I say it is a negligible increase that doesn't translate really into people. If I am 60 years old and have almost total occlusion of 6 vessels my outcome is more risky than say a 48 year old having partial occlusions in 2 vessels. To lump all patients together regardless of severity levels is probably where they got their numbers.

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snipped by j2m
thank you! that is how I was taught math too :blowkiss:

Peter Hamilton said:

--My mother has two stents also--She got them last June--She didn't have a heart attack but they found 2 arteries 99% blocked--but unlike your mother, my mother did NOT quit smoking, she still does not eat healthy, and she still won't look at labels--My mother needs some of your mother's common sense--btw my mother is 78, what's your mother's age?

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My mother is only 58. Her heart attack was in July. She drove herself to the hospital after experiencing chest pains for several hours that could not be relieved... She also had severe pain in her right hand between her thumb and index fingers. She was in the hosptial for three days and has not been the same since! She was heavy, smoked about 3 packs a day and ate what she wanted. She has really done a complete turnaround.. She has more weight to go, but I am sure she will lose it all as long as she keeps up her good behavior..
Oh and she also walks on her treadmill for 30 minutes each morning... This from a women who's idea of excersize used to be picking up the remote while laying on the couch..

That heart attack scared the crapola out of her!

paddy01 said:

Marthatex, I'm very glad that you posted this information, we need to be informed. I thank you. I will indeed check this out further with husbands cardiologist.

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Your welcome; I didn't realize so many here would be affected by stents/bipasses; the report made it sound like a blow for using stents.