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Stents or bypass surgery for clogged arteries?

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Are stents or bypass surgery more effective in preventing a future heart attack? A study published last Monday in JAMA Internal Medicine tips the balance clearly in favor of bypass surgery as the more effective route to prevent a future heart attack or heart disease death in those with multiple clogged arteries. Another study published in the same journal finds that getting a stent in addition to taking medication is no better than drug therapy alone for preventing heart attacks and death in those with a single clogged artery.

The first study looked at six previously published trials involving more than 6,000 heart disease patients with multiple clogged arteries who were randomly assigned to have bypass surgery — where diseased portions of the heart arteries are replaced with transplanted vein or artery grafts — or a less invasive stent placement to prop open a clogged artery. Those who had the bypass were 27 percent less likely to die over the four-year study and 42 percent less likely to have a heart attack than those who had the stents.

In the second study, researchers found that placing stents made no difference in heart attack rates or deaths in patients compared to those who took only medications to prevent heart problems. These two trials only involved patients with stable heart disease — not those having a heart attack or chest pain who were treated during emergencies.

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