(Press-News.org) NEW YORK, March 16, 2015 - Newer drug-coated stents that keep arteries open have similar long-term rates of death compared with traditional bypass surgery for patients with more than one diseased coronary artery.
The findings come from a clinical registry study, led by cardiologists at NYU Langone Medical Center, which appears in this week's issue of the New England Journal of Medicine.
In the study, a sample of over 9,000 patients who received the latest stents were no more likely to die in the few years following the procedure, compared to a matched sample of over 9,000 patients who underwent bypass surgery instead.
Clinical practice in this area is still largely guided by past studies of bare-metal and first-generation drug-coated stents--studies that found greater long-term risks of heart attack and death from the devices, compared to traditional bypass surgery.
"We aren't using older stents anymore, so this study gives us some insight into more up-to-date clinical outcomes," says Sripal Bangalore MD, an associate professor in NYU Langone's Leon H. Charney Division of Cardiology, Department of Medicine, who was lead author of the study.
Stents are metal mesh tubes that are threaded into the heart through a leg or an arm artery using a catheter. They are then expanded to keep a blocked coronary artery open indefinitely. Introduced in the late 1980s, they are now commonly used to open blocked arteries in acute heart attack cases, and to widen narrowed vessels in less severe cases of cardiovascular disease. Hundreds of thousands of patients receive stents each year in the U.S.
The technique for inserting a stent--called percutaneous coronary intervention, or PCI--requires a much shorter hospital stay than traditional open-heart bypass surgery, and is much less likely to trigger strokes.
In the longer term, however, early generation stents have seemed prone to react with heart vessels in a way that promotes inflammation, scar tissue growth and the eventual re-closing of arteries. In addition, early generation stents were more prone for developing blood clots inside the stent, even many years after stent implantation, resulting in death or heart attack.
The new study made use of data from New York state registries that track cardiovascular procedures. From nearly 35,000 cases during 2008-2011, the researchers selected two groups of 9,233 patients with multi-vessel disease that were closely matched in age and other relevant measures. One group had undergone bypass surgery, the other PCI with a new generation of stent that is coated with the drug everolimus to inhibit inflammation and scar tissue growth.
As expected, the stent group fared better in the first 30 days, with only half the number of deaths and one-sixth the number of strokes seen in the bypass group. But in contrast to previous studies, the stent group didn't seem to fare worse in the longer term. During the period from 30 days to about three years on average, the numbers of deaths in the two groups were not significantly different.
Patients in the stent group got about 1.5 times the number of heart attacks long-term, compared to the bypass group, but for those patients whose stents successfully opened all of their diseased arteries, there was no significant increase in heart attacks.
Bypass surgery showed a clear advantage only in the percentages of patients who had to return to have an artery reopened: 3.1 percent for the bypass group, versus 7.2 percent per year for the stent group.
"The key finding is that there was no greater mortality in the sample of patients receiving the latest generation stents," says Dr. Bangalore. "This may encourage patients and physicians to weigh the risks and benefits of stenting versus bypass surgery, now that we have further information."
Although this was an observational study, not a randomized clinical trial, Dr. Bangalore notes that its results are consistent with a general trend in New York clinical registry studies. "Over the last twenty years of these registry studies, the gap in apparent mortality risk between bypass and PCI has been getting smaller and smaller as stent technologies have advanced," he says.
INFORMATION:
The study was a collaboration between Dr. Bangalore's group and a team led by Edward L. Hannan, Ph.D., Distinguished Professor of Health Policy, Management and Behavior at the School of Public Health, SUNY-Albany. Besides Dr. Bangalore and Dr. Hannan, co-authors were Yu Guo, Saul Blecker, MD and Jinfeng Xu, PhD of NYU Langone, and Zaza Samadashvili, MD of the School of Public Health at SUNY-Albany.
The study was funded by Abbott Vascular, a division of Abbott Laboratories, which makes one of the two everolimus-coated stents now on the market.
SAN DIEGO (March 16, 2015) -- Among patients with heart failure and atrial fibrillation, those who underwent catheter ablation were less likely to die, be hospitalized or have recurrent atrial fibrillation than patients taking a heart rhythm regulating drug, according to a study presented at the American College of Cardiology's 64th Annual Scientific Session.
Catheter ablation was most successful in procedures where ablation was required in other areas in addition to the pulmonary vein, researchers said.
Heart failure and atrial fibrillation often co-occur and are two ...
SAN DIEGO (March 16, 2015) -- Patients with atrial fibrillation who received ablation while they were already undergoing surgery to correct a leaky heart valve had fewer episodes of atrial fibrillation a year later compared to patients who had the valve surgery alone, according to a study presented at the American College of Cardiology's 64th Annual Scientific Session.
The patients who received ablation along with mitral valve surgery had no more deaths, adverse cardiac events or hospitalizations than patients who only received the valve surgery alone, but they were ...
SAN DIEGO (March 16, 2015) -- Patients who underwent a simple conditioning procedure involving the inflation and deflation of a blood pressure cuff on the upper arm before coronary artery bypass grafting, known as heart bypass surgery, had no better long-term health outcomes than bypass patients who did not receive the conditioning, according to research presented at the American College of Cardiology's 64th Annual Scientific Session in San Diego.
The study, the first large randomized controlled trial to investigate the effectiveness of remote ischemic preconditioning ...
Researchers have identified a new host of gene variants that could make people vulnerable to sporadic motor neurone disease, according to a report published today in the journal, Scientific Reports.
Until recently, it was thought that genetics made little contribution to the disease - also termed amyotrophic lateral sclerosis (ALS) - and that the environment was mostly to blame.
Currently two to three thousand Australians are living with this fatal disease. Motor neurone disease (MND) is a group of diseases in which the nerve cells in the brain and spinal cord controlling ...
BEER-SHEVA, Israel...March 15, 2015 - Ben-Gurion University of the Negev (BGU) researchers have developed a groundbreaking approach to determine sleep quality using their new breath sound analysis (BSA). This is less expensive and invasive than current polysomnography (PSG) technology, according to a new study published on PLOS Online.
"One of the main goals of sleep medicine today is to improve early diagnosis and treatment of
the 'flood" of subjects presenting with sleep disorders," says Prof. Yaniv Zigel Ph.D., head of the Biomedical Signal Processing Research Lab ...
Research shows that depictions of race on television news programs can strongly influence support for police among non-white viewers. The study was conducted by researchers at North Carolina State University, the University of Utah, Indiana University and the University of California, Los Angeles.
"Black men and women - particularly black men - are over-represented as criminals or criminal suspects on TV news, and under-represented as law enforcement or authority figures, and as victims of crime," says Dr. Ryan Hurley, an assistant professor of communication at NC State ...
This news release is available in German.
Leipzig/Berlin. A public and scientific discussion is currently taking place focusing on the question whether substances at low concentrations may lead to health impairments in humans. For this reason, an increasing number of experimental studies to test such effects are currently conducted using different chemicals. It was possible to demonstrate, for example, that even low quantities of benzo[a]pyrene can have effects on the protein pattern and hence the metabolism and signal pathways in cells, even though the concentration ...
WASHINGTON, March 16, 2015 -- It's been around for centuries but it seems like beer has never been more popular. Microbreweries are cranking out special stouts, IPAs, lagers and pilsners. And the flavors and aromas of each of those brews all come down to chemistry. This week, in honor of St. Patrick's Day, Reactions takes on craft beer chemistry. Sip on the video here: https://youtu.be/vW99JEaDApY.
INFORMATION:Subscribe to the series at http://bit.ly/ACSReactions, and follow us on Twitter @ACSreactions to be the first to see our latest videos.
The American Chemical ...
Cells have two different programs to safeguard them from getting out of control and developing cancer. One of them is senescence (biological aging). It puts cancer cells into a permanent sleep so they no longer divide and grow in an uncontrolled way. Now the research group led by Professor Walter Birchmeier (Max Delbrück Center for Molecular Medicine, MDC, Berlin-Buch) has discovered that an enzyme known to be active in breast cancer and leukemia blocks this protection program and boosts tumor growth. They succeeded in blocking this enzyme in mice with breast cancer, ...
This news release is available in Spanish.
The researchers explain that online health information searches are the third most popular activity in Google, with 170,000 searches performed every 5 seconds. Isabel Segura Bedmar of the UC3M Computer Science and Engineering Department points out that, "There is a lot of user-generated information these days, so social networks can be a valuable source of information on adverse effects of pharmaceutical drugs after the clinical trial stage is over and the drug is on the market." The large amount and variety of information ...
