reatment of blockages in the heart arteries is done from two viewpoints- one to improve quality of life on durable basis and second to prevent further heart attacks.

Unfortunately all studies show that stents fail on both fronts as compared to bypass surgery. And yet, thousands of patients are subjected to angioplasty and stents against these guidelines.

The other parameter in these trials is death, to see which procedure prevents fatality. It’s clear from these trials that the incidence of death from first heart attack after angioplasty is 10 times higher than bypass surgery. The reason is that when stents block, they block suddenly and are followed by a fatal heart attack. But when bypass grafts fail, they fail slowly. The trials were conducted on a large population, 1800 patients. With similar morbidities and based on number of blockages as well as by defining a syntax score that created three groups of these patients with low.

Intermediate and high score groups. Intermediate and high score patients are in any case only benefit from bypass surgery, which is well established. Another significant point was that the more complex a blockage is, more the chances of stent failure, but not so in case of bypass surgery The other relevance of this study was to see all causes of death after both procedure. Which was 10 times more in stent group than in bypass surgery, making it one reason to choose bypass.

Scent is an artificial thing put into the body and there is a reaction generated to it which leads to intimal growth and stent blockage. To check this internal growth came drug coated stents but they also do not prevent sudden death. It is important to understand that second procedure required after stents is a non-event, but is not true about death.

So it’s well-supported that for multi-vessel blockage, complex or intermediate bypass surgery which uses one’s own tissues is a better
and desirable solution. Probably another reason for this is that in surgery all blockages are tackled in one go which many times cannot be done with stents and this residual blockage are the cause of second procedure or even death.

Despite this scientific evidence, many cardiologist still keep on recommending stents to their patients with multiple blockage worldwide and as per the New York state data, this number is as high as 53%. The logic often given that these are new generation drug coated stents in current practice also does not hold good as with these stents also results are same where bypass surgery wins.

So for fear of surgery or undergoing the procedure at a young age, should not lead to choosing stent, which is not only non-durable but is a risk to life, later on. The argument that at young age one should get stents to save surgery for second time is wrong as it will happen only if patient survives. So cardiologist should be generous enough to tell this risk of death being 10 times more than bypass surgery more transparently to all patents suffering from multiple blockage.

The above article has been contributed by Dr Virendar Sarwal of Ojas Super Speciality Hospital

Disclaimer:The veracity of any health claim made in the above article is the responsibility of the concerned hospital/doctor.