Bypass Surgery Remains Best Option

Despite advancements in stents, coronary artery bypass grafting (CABG) still prevails over balloon angioplasty and stents as the better treatment method for patients with multiple narrowed arteries in the heart.

Findings from the new study, Bypass Surgery Versus Everolimus-Eluting Stent Implantation for Multivessel Coronary Artery Disease (BEST) trial, emphasizing current guidelines, were presented at the American College of Cardiology meeting in San Diego, CA and simultaneously published online in the New England Journal of Medicine.

Seung-Jung Park, MD, a cardiologist at Asan Medical Center, Seoul, South Korea, and the study’s lead author said, “Based on our data, CABG is still the preferred option for multivessel disease. We had thought that previous trials may have been limited by their use of first-generation drug-eluting stents, but these results show CABG still leads to better outcomes.”

One of only 2 randomized controlled trials comparing bypass to angioplasty following the foray of everolimus-eluting stents, the 4.5 year-long study included a total of 880 patients with multivessel CAD — determined to be randomized for either angioplasty or bypass.

Park commented, “During this relatively long-term follow-up, angioplasty was associated with a significant increase in the incidence of the death, myocardial infarction and target vessel revascularization, a difference that was mainly attributed to the higher rate of target-vessel revascularization in the angioplasty group.”

It noted that 15% of patients in the angioplasty group and 11% in the bypass group experienced one of the outcomes identified as a primary endpoint in the study: death, heart attack, and subsequent procedure to clear blocked arteries.

Also, researchers noted that compared to bypass patients, those administered angioplasty were twice as likely to require repeat revascularization and approximately 1.8 times as likely to experience heart attacks.

The study was cut-short, because of slow enrollment following the increased appeal of a new angioplasty technique, fractional flow reserve, limiting its statistical power to detect differences in individual outcomes instead of only composite outcomes.

Researchers shared that a new study had already begun to compare results from bypass to angioplasty using fractional flow reserve in patients with multivessel CAD.

Results concluded, “Because it is a more invasive procedure, heart bypass is generally recommended only for patients with higher-risk narrowing in two or more arteries. Angioplasty is preferred for patients with lower-risk narrowing in one or two arteries.”