Bypass operation or stent?

Every year in Germany, about 370,000 people in whom a narrowing (“stenosis“) of the coronary arteries has been diagnosed are faced with this decision. About 80 percent of them will have insertion of one or more metal tubes (“stents“), but only about 20 percent will have bypass surgery. In many cases, stent insertion is not the correct choice, as shown by the results of the world’s biggest study comparing the two treatments, presented in September 2009 at the conclusion of the second year of the study. The latest results of the “Synergy between PCI with taxus and Cardiac Surgery“ (Syntax) study, conducted jointly by cardiologists and cardiac surgeons and based on about 1,720 patients, show that bypass surgery is superior to both uncoated and drug-coated stents with regard to the incidence of death, myocardial infarction and the need for a further procedure. Although the results for all patients are close together two years after treatment with regard to deaths (10.8% with stents, 9.6% with bypass), the incidence of death with treatment of the very complex conditions of main stem stenosis and 3-vessel occlusion was about three times higher two years after stent insertion than after bypass surgery. Moreover, further procedures were performed twice as often after stent insertion, with a rate of 17.3 percent, than in the same period after bypass surgery, when the rate was 8.6 percent. Finally, the myocardial infarction rate after stent insertion was 5.9 percent, which was significantly higher than after bypass surgery (3.3%). These results correspond to the results of a register started a few years ago in New York on this subject.

In summary, the recent results of the Syntax study impressively reinforce the study analysis after the first year and again confirm the “National treatment guideline for chronic CHD“ on the optimal treatment of patients with coronary heart disease, published jointly in June 2006 by cardiologists and cardiac surgeons. The conclusion is that bypass surgery is clearly superior to stent insertion especially in more difficult cases such as coronary 3-vessel disease. (Data from the German Society for Thoracic, Cardiac and Vascular Surgery and press release of 23.9.2009).