In today’s microwave society, where results are sometimes wanted yesterday, coronary stent procedures have proven to be an amicable solution for treating diseased arteries. Recovery time is fast — sometimes as quick as three days — compared to the six weeks it would take someone to recover from bypass surgery.

But does this mean that stenting is the better and most efficient option?

A study conducted by the Agency for Healthcare Research and Quality (AHRQ) says no and points out that patients experienced fewer repeat procedures and less angina or chest pain with coronary artery bypass grafting (CABG) surgery than with percutaneous coronary interventions (PCI) such as stents.

The report comes on the heels of the mounting controversy surrounding the usefulness of drug-eluting stents (DES) and could be a blow to the stenting industry as a whole.

“Some cardiologists would say the only reason to have bypass surgery was if stenting had failed. That is completely false,” Robert Guyton, MD, chief of cardiothoracity at Emory University (Atlanta), told Medical Device Daily. “There is a growing awareness out there that stenting isn’t the answer for coronary artery disease. [Stenting] is useful in early and intermediate stages but surely not the advanced stages and [for] handling multiple blockages.”

CABG is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient’s body are grafted from the aorta to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass. However, recent research has also shown that this surgery can be done with the heart still beating, by putting stabilizing devices on the heart.

Stents provide a mechanical framework that hold the artery walls open, preventing stenosis, or narrowing, of coronary arteries.

The problem according to Guyton is that stenting fixes one single blockage in a vessel and does nothing to address the remainder of the diseased artery. Bypass surgery, however radical it could be perceived, addressed the total picture.

“In patients with advanced coronary artherosclerosis- generally patients with more than two and certainly patients with more than three major blockages – CABG as initial therapy offers not only the best chance of angina relief and freedom from repeat procedures, but also a substantially better chance of survival at three to five years compared to angioplasty with stents as initial therapy,” said John Mayer, MD, president of the Society of Thoracic Surgeons (Chicago). “Because this information is so important, it is critical that both cadiologists and primary care physcians educate their patients so they can help them make informed treatment decisions.”

The study, which followed more than 10,000 patients in 23 randomized trials, found that almost 84% of bypass surgery patients were free of angina pain one year after the procedure compared to 75% of patients who underwent the stenting procedure. It also points out that about 24% more angioplasty patients had a repeat procedure within one year compared to those who had bypass surgery.

The study also concluded that quality-of-life scores improved significantly for three years following CABG compared with PCI. The degree of improvement in quality of life was correlated with relief of angina.

So why the turn toward stenting procedures in the face of such good numbers for CABG procedures in the first place?

Guyton says the answer behind this question is largely patient-driven.

“It has to do with everybody wanting a quick easy fix instead of spending the time to address the entire problem,” he said.

But some physicians say this report could be the start of changing the current mindset.

“Choosing a treatment for coronary disease has long been a difficult challenge,” said AHRQ Director Carolyn Clancy, MD. “But this new evidence-based report provides a vital reference to help doctors, patients and their families make the best possible decision.”