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No Mortality Difference Seen Between Stenting and Bypass Surgery After 5 Years: Presented at ESC(CARD)2004

By Ed Susman

MUNICH, GERMANY -- September 1, 2004 -- After 5 years of follow-up, researchers found find no difference in mortality among patients who underwent coronary artery bypass surgery and those who received angioplasty with stenting, doctors said Wednesday.

"What we found that was surprising in the mortality data was that half the deaths that occurred in this study were due to non-cardiac causes, even though the average age at onset of the trial for heart disease patients was 61 years," said Patrick Serruys, MD, Professor of Interventional Cardiology, Interuniversity Cardiological Institute of The Netherlands and Erasmus University, Rotterdam, The Netherlands.

Overall, 8% of the 600 patients assigned to the angioplasty plus stenting arm of the trial died, 43.8% of them from heart disease. The overall survival of these patients was 92.4% after 5 years. Of the 605 patients randomised to receive bypass surgery, 7.6% died, 58.7% of them from cardiac causes. The overall survival of these patients was 92%. The difference in death rates were not statistically significant, Dr. Serruys said in a press briefing at the European Society of Cardiology 2004 Congress.

Similarly, there were no significant differences between the two groups when looking at overall death, stroke or heart attack rates. About 85.1% of those undergoing surgery were free of those outcomes after 5 years compared with 81.8% of those who received angioplasty plus stenting.

However, there was almost a doubling of events when the researchers looked at patients who required revascularisation during the 5-year period after initial treatment, Dr. Serruys reported. About 10.5% of the patients who received stents required bypass surgery compared to 1.2% of surgery patients who needed a repeat procedure. Repeat angioplasty was needed by 23.2% of the stented patients and angioplasty was required by 8.7% of the surgery patients. Overall revascularisation was required by 30.3% of the angioplasty patients compared with 8.8% of the surgery patients (P <.001).

"Clearly, the event rate was driven by revascularisation," Dr. Serruys said. After 5 years, 58.3% of the angioplasty patients were event free compared to 78.8% of the surgery patients.

"It should be pointed out that this study was conducted using bare stents and that a similar study using coated stents might reduce the number of revascularisations," said Peter Kearney, MD, Consultant Cardiologist, University Hospital, Cork, Ireland. Dr. Serruys said discussions are underway to determine how to perform such a trial.

He said a decision on which procedure is best for an individual patient would be driven by the patient's relationship with his doctor.


[Abstract title: "Hot Line and Clinical Trial Update II: ARTS I: 5-year Clinical Follow-up of the Arterial Revascularization Therapy Study." Abstract 3601]

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