Research by Barts Health NHS Trust shows that young people with severe coronary artery disease may be better off being treated with bypass surgery, instead of the current less invasive treatment using stents.
Surgeon Mr Awad and his team at St Bartholomew’s Hospital compared outcomes over five years, and again at twelve years, for two hundred patients aged under 50 requiring treatment for coronary artery disease*. Split into two groups, one hundred people each underwent one of the two main procedures to treat severe coronary artery disease; bypass grafting surgery and stenting. Both treatments increase blood flow to the heart muscle.
The research at St Bartholomew’s Hospital shows that those who were treated with a stent were far more likely to suffer complications and require further treatment, despite it being the more widely used procedure.
Within five years, nine per cent of patients with a stent had experienced a heart attack and 37 per cent required further re-intervention. This is compared to just one per cent of those who had surgery having a heart attack and seven per cent requiring further treatment.
After twelve years, the risk continued to be considerably higher in those who did not have surgery. Those with more serious heart disease, with blockages in three blood vessels, were seen to be at particularly high risk. Researchers say their findings support making surgery the preferred treatment for young patients (aged under 50) with three-vessel coronary artery disease.
Nationally, approximately one quarter of patients undergo coronary artery bypass surgery, while three quarters undergo stenting. This is based on the coronary artery anatomy, extent of disease, patient fitness but also patient preference for the less invasive stenting. The procedure and recovery time for stenting is shorter, meaning that patients can more quickly return to work or to look after family. In contrast, coronary artery bypass grafting requires a general anaesthetic and surgical opening of the chest, with a 5 -7 day stay in hospital and 4 weeks of rehabilitation. But research by the team at St Bartholomew's suggests surgery could in fact be the preferred option for a select group of patients.
As Mr Wael Awad, cardiothoracic surgeon at Barts Health NHS Trust, explained: “This trial is unique in that we have studied young patients, those who most rely on long-term successful outcomes. It is understandable that many patients, especially younger ones, will choose to have less invasive procedures but this research shows that patients should understand that a less invasive procedure is associated with less durable results and worse outcomes, especially in those with multi-vessel coronary artery disease."
Mr Awad presented his research at the Society of Thoracic Surgeons, the largest cardiothoracic meeting worldwide.
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Notes to Editors
*Coronary artery disease is a build-up of plaque in the artery wall resulting in reduced blood flow to the heart muscle, leading to angina or a heart attack.
Bypass grafting requires surgeons to take a length of artery or vein from elsewhere in the patient to then use to bypass blood past the narrowed artery.
In stenting, a metal tube is placed across the narrowed coronary artery allowing blood to flow.
The operations were performed between January 2004 and December 2004 at the London Chest Hospital, with patients followed at intervals of 5 and 12 years.