STANFORD, Calif. - Stanford University Medical Center researchers have developed a computer model showing that bypass surgery is more cost-effective in the long run than stents in patients with two or more blocked coronary arteries. Not only does surgery ultimately cost less but it results in a better quality of life, including less chest pain. The results hold even when comparing surgery to newer stents coated with drugs to keep vessels from re-narrowing.

"Stents are hugely popular but also expensive. It's not really clear that the benefit is there for all the patients who receive them," said Cynthia Yock, research associate in the Center for Primary Care and Outcomes Research and lead author of the study that appears in the October edition of the American Journal of Medicine. While it requires less hospitalization time and initially costs less than surgery to install a stent, the savings are lost over roughly five years as these patients suffer greater recurrent chest pain and undergo repeat procedures more often than surgery patients.

To compare these two common artery-clearing treatments, researchers took advantage of previous data from the Bypass Angioplasty Revascularization Investigation, or BARI, conducted from 1988 to 1991. That study compared more than 1,800 patients with two or more coronary arteries blocked who were randomly assigned bypass surgery or angioplasty, a procedure that uses tiny balloons to open blocked arteries. In patients tracked over more than a 10-year period, the study found no significant differences between the two groups other than angioplasty patients requiring repeat procedures more often than surgery patients.

Stents, which help hold blood vessels open after angioplasty, were just becoming available after patients in the BARI trial had received their initial treatments. Since then, the hardware has rapidly taken over; more than three-quarters of angioplasty procedures now include stents. "The technology ad
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Contact: Mitzi Baker
mitzibaker@stanford.edu
650-725-2106
Stanford University Medical Center
2-Oct-2003

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