New research suggests that heart stents may carry a higher risk of major side effects compared to heart bypass grafting surgery, potentially resulting in more heart attacks and additional surgical procedures.
In a study published last month in the medical journal The Lancet, researchers from across the European Union found that patients had better outcomes with the coronary artery bypass grafting (CABG) surgery, or heart bypass graft, compared to those who received a heart stent.
The preliminary findings of the NOBLE randomized clinical trial were first released in 2016, indicating heart grafts were a better bet for patients compared to heart stents. However, the study hadn’t reached the predetermined number of outcomes needed for a full analysis at that time, so the study was continued. Now, that predetermined number has been reached and the final conclusions are similar to the preliminary findings.
Researchers compared the standard coronary artery intervention, coronary artery bypass grafting, to percutaneous coronary intervention (PCI), which involve the placement of heart stents. Stenting is used more in revascularization of patients with main coronary artery disease instead of the standard treatment. However, researchers wanted to determine if one had better outcomes than the other.
The clinical trial was conducted at 36 hospitals in nine northern European countries from 2008 to 2015, involving 1,200 patients, with half allocated to bypass surgery and half to stents. Patients had an average follow-up of five years.
The researchers determined that heart stents had an inferior clinical outcome at five years, when compared to bypass grafts. Bypass surgery had fewer serious side effects and had similar death rates as stent surgery. Patients who received stents had higher rates of heart attacks and repeat revascularization.
The rates of major adverse cardiac or cerebrovascular side effects were higher among stent patients, who had a 28% rate of major side effects compared to 19% among bypass patients.
Death rates were nearly identical for both sets of patients, at 9% for both bypass grafts and heart stents. Similarly, rates of stroke were comparable at 4% for stent recipients and 2% for bypass patients.
Other studies have shown heart stents are not that effect at relieving chest pain among patients suffering angina, even though the devices are often specifically recommended for this purpose.
Another study published in 2018 reached similar conclusions, indicating patients with heart stents often don’t experience alleviated symptoms of stable angina. Instead, researchers indicated a placebo effect may be leading to some patients experiencing improved chest pain after having PCI surgery since most don’t.
Furthermore, many doctors perform unnecessary stenting procedures on patients with low levels of artery blockage at rates less than 50%. Medical recommendations only call for stents to be performed if the blockage is above 70%.
Researchers recommend patients who are eligible for both procedures should talk to their doctor about the benefits and risks of both and be well informed before making a decision. In most cases, bypass grafting surgery should be recommended because of its lower risk to patients, they determined.