Avoiding a Bypass

Minimally invasive cardiac procedure effect for low risk patients

(RxWiki News) Just the thought of a bypass operation is scary for most people. But it may be that lower risk heart patients can opt for a surgery that is just as effective only not as invasive.

New research shows that low risk cardiac patients with left main coronary artery disease, one of the most serious types of heart disease, would have a long term favorable outcomes with angioplasty and medication-coated stents. The less invasive operation would be performed instead of bypass surgery.

Angioplasty widens the artery with a balloon catheter by snaking a tiny wire from the groin to the blocked portion of the heart. After the artery is unclogged stents, or tiny wire-mesh tubes, are placed to keep the artery open, allowing for blood flow to the heart.

"Ask your cardiologist if you are a candidate for a minimally invasive heart procedure."

UCLA researchers found that the alternative procedure may be safe for patients with left main coronary artery disease with normal artery function. Existing national guidelines suggest angioplasty with stenting only for patients who are poor candidates for surgery.

Dr. Michael Lee, an assistant professor of cardiology at the David Geffen School of Medicine at UCLA, said that could change in the future, if more studies like this one demonstrate the procedure's effectiveness in a wider range of patients.

For the study researchers reviewed data compiled from an international registry about 221 patients with left main coronary artery disease with normal artery function. All of the patients had undergone angioplasty with drug-eluted stents between 2002 and 2009 at one of four facilities. The average patient was 68, and most were men.

The patients opted for angioplasty with stenting instead of surgery for several reasons, including high surgical risk due to health issues like chronic obstructive pulmonary disease or a severely calcified artery, older age, or a preference for the more minimally invasive procedure.

In examining 30-day outcomes for patients in the study group, there were no reports of cardiac death, stroke, re-clogging of the artery or blood clots forming related to the stent. Seven patients experienced a mild heart attack that can occur during the procedure, but those were still considered mild events.

About 62 percent of patients were tracked and at one year, the cumulative event-free survival rate for cardiac death was 97.7 percent, and the event-free rate for artery re-clogging was 92.9 percent. Over the course of the study, 22 patients needed to be retreated due to the artery re-clogging, and this occurred mostly in the first year. Of those patients, 14 underwent a repeat angioplasty and eight had bypass surgery.

At nearly four years, the event-free survival rate for cardiac death was 95.5 percent, and the event-free rate for re-clogging of the artery was 88.9 percent. Of the original study participants, 20 had died, nine of which were heart related.

The next step in the research is clinical trials comparing angioplasty with drug-eluting stents to coronary bypass surgery in this lower-risk patient population. The study was published in a recent issue of the journal Catheterization and Cardiovascular Interventions.

Review Date: 
June 23, 2011