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Minimally Invasive CABG May Be Better Than Stent

Three studies suggest stents are less efficacious and cost-effective than minimally invasive bypass surgery for some patients

FRIDAY, March 23 (HealthDay News) -- When it comes to revascularizing the heart, some patients may be better off with minimally invasive coronary artery bypass than stenting, according to three reports published in the March 24 issue of BMJ. The findings call into question the proliferation of stent procedures, which now outnumber surgical interventions by four-to-one.

Thanos Athanasiou, M.D., Ph.D., of Imperial College London, and colleagues performed a meta-analysis of 12 studies encompassing 1,952 patients that compared stenting and minimally invasive left internal thoracic artery bypass in patients with isolated lesions of the left anterior descending artery.

There was no difference in the rate of myocardial infarction, stroke or mortality. However, recurrence of angina (odds ratio, 2.62), the risk of repeat revascularization (OR, 4.63) and major adverse coronary and cerebral events (OR, 2.86) were higher in patients who had stents. An additional study by Athanasiou found that bypass surgery was more cost-effective than stents for such patients. And a third study by Harry Hemingway, M.D., of the University College London Medical School, found that stenting was not cost-effective compared to bypass grafting or medical management alone, depending on the type of lesions.

"A multidisciplinary approach should be a minimum mandatory 'standard of care' to ensure that patients are offered the most clinically appropriate treatment," according to an editorial by David Taggart, M.D., Ph.D., of the University of Oxford, U.K.

Abstract -- Aziz
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