* Combined heart attack, stroke, death in 18.7 pct in bypass
* Rate significantly higher at 26.6 pct in stent group
* Strokes higher in bypass group 5.2 pct vs 2.5 pct
* Twice as many heart attacks within 5 yrs in stent group
* Results could change clinical practice - doctors
By Bill Berkrot and Deena Beasley
LOS ANGELES, Nov 4 Diabetics with more than one
diseased artery fared significantly better if they underwent
bypass surgery than those who received drug coated stents
following artery clearing procedures to improve blood flow to
the heart, according to data from a five-year study presented on
After five years, the bypass group had a lower combined rate
of heart attacks, strokes and deaths of 18.7 percent versus 26.6
percent for the stent group in the 1,900-patient study funded by
the U.S. National Institutes of Health.
The result was deemed to be highly statistically
significant, researchers said.
Previous studies had demonstrated the superiority of bypass
surgery over the use of bare metal stents - tiny mesh tubes used
to prop open cleared arteries. Researchers suspected that newer
stents coated with drugs to prevent reclogging might negate some
of the bypass advantage, but that turned out not to be the case.
"The advantages were striking in this trial and could change
treatment recommendations for thousands of individuals with
diabetes and heart disease," said Dr. Valentin Fuster, from
Mount Sinai School of Medicine in New York, who presented the
findings at the American Heart Association scientific meeting in
There was a higher incidence of stroke in bypass patients --
5.2 percent versus 2.4 percent. Stroke is a known risk of the
surgical procedure in which a piece of a healthy blood vessel
from another part of the body is grafted on to re-route blood
flow around a blocked heart artery.
But deaths from any cause were significantly lower with
bypass surgery than those who received artery clearing
angioplasty and a drug eluting stent - 10.9 percent compared
with 16.3 percent. There were also twice as many heart attacks
among diabetics in the stent group within five years - 99 vs 48,
which Fuster called "very significant."
More than one million bypass surgeries or stenting
procedures are performed in the United States each year and some
25 to 30 percent of those involve diabetics with multiple
diseased arteries, researchers said.
If the results of this study alter clinical practice, it
could eat into lucrative profits of the companies that sell drug
coated stents, such as Abbott Laboratories, Boston
Scientific Corp and Medtronic Inc. Boston
Scientific and Johnson & Johnson supplied the stents
used in the study, but J&J has since exited the stent business.
Dr. David Williams of Brigham and Women's Hospital in
Boston, who was not involved in the study, called the results
"I think the (treatment) guidelines will recognize this and
I do think it will be adopted," he said.
However, Fuster cautioned that longer term follow-up of
patients was necessary.
"We always want to know how long the effects last," he said.
"The gap could begin to close or the results could get better