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Why diabetics should choose bypass surgery over stents for clogged heart arteries

Every year, 175,000 diabetics who have multiple blockages in their heart arteries elect to undergo either bypass surgery or angioplasty with stenting to relieve symptoms such as chest pain, shortness of breath, and fatigue. Most choose to have stents since the procedure is less invasive with a far shorter recuperation time, but bypass surgery turns out to be a much safer option, according to a study presented this week at the American Heart Association’s annual meeting in Los Angeles.

A multi-center research team -- including scientists from the New England Research Institutes in Watertown and Brigham and Women’s Hospital -- randomly assigned 1,900 heart patients with diabetes to either undergo bypass surgery or receive a drug-coated stent to open two or more blocked heart arteries. About 19 percent of those who underwent bypass surgery suffered a heart attack or stroke or died within five years compared with nearly 27 percent of those who received a drug-covered stent.

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“These results were very striking,” said Dr. Valentin Fuster, the study’s senior author and director of the heart program at Mount Sinai Medical Center in New York. “In a majority of places in the world, these patients were receiving stents. This is going to change practice.”

The number of heart disease deaths didn’t differ significantly between the two groups, according to the study published online in the New England Journal of Medicine, but heart attacks and deaths from any cause were higher in the group that received stents. Strokes were higher in the bypass patients.

The most striking difference came from new or reformed blockages within one year after the procedure that necessitated a procedure to re-open the artery. About 13 percent of stent patients experienced a troublesome blockage compared with 5 percent of those who had bypass.

Elective procedures such as stenting and bypass to open blocked arteries -- where there’s no sign of a heart attack or other life-threatening heart problem -- have come under scrutiny in recent years as research has shown time and again that these procedures ease heart symptoms but don’t help heart patients live longer.

“Patients with diabetes ought to be informed about the potential survival benefit” of bypass surgery if they have more than one clogged artery, Stanford University cardiologist Dr. Mark A. Hlatky wrote in an editorial that accompanied the study. “These discussions should begin before coronary angiography in order to provide enough time for the patient to digest the information, discuss it with family members and members of the heart team, and come to an informed decision.”

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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