Coronary heart disease bypass or stent which is better?

According to the American Heart Association (AHA), in the United States, 40% of people over the age of 60 suffer from coronary stenosis

Bypass surgery requires an open chest and is relatively more traumatic

The FAME 3 study, recently published online in the New England Journal of Medicine (NEJM), answers this question and helps doctors decide which treatment option is best for their patients

FFR is an indicator of hemodynamics, measured by a pressure guidewire, and combined with FFR allows for a more accurate assessment of coronary stenosis than angiography alone

The large study was conducted at 48 medical centers in Europe, North America, Australia and Asia

About half of the patients in the study were randomized to the stent group, with an average of 3.

Overall, in patients with three-vessel coronary stenosis, FFR-guided stenting was inferior to bypass surgery in terms of the 1-year composite rate of death, MI, stroke, or repeat revascularization

After 1 year, the composite primary endpoint was 10.

Specifically, the rates of death, MI, or stroke were 1.

However, in terms of safety, patients in the stent group had lower rates of bleeding, acute kidney injury, atrial fibrillation/arrhythmia, and readmissions within 30 days compared with the bypass group

However, when analyzing patient data based on the SYNTAX score of coronary lesions, the research team observed different results, which have direct implications for the choice of treatment strategies

The SYNTAX score is mainly aimed at left main coronary artery disease and/or three-vessel disease.

For patients with lower SYNTAX scores, the probability of adverse cardiovascular and cerebrovascular events within one year of stenting was lower than that of bypass surgery

However, for patients with high SYNTAX scores, the probability of adverse cardiovascular and cerebrovascular events within one year of stent patients was higher than that of bypass patients (p=0.

"Overall, this study demonstrates that both stenting and bypass surgery are important treatment options, and surgeons should take the most Best treatment strategy: If the patient's disease is very complex and more stents are needed, bypass may be a better option to avoid repeat surgery

References

[1] William F.

[2] Study compares bypass, stenting for patients with severe heart disease.
Retrieved NOVEMBER 5, 2021, from https://medicalxpress.
com/news/2021-11-bypass-stenting-patients-severe-heart.
html

[2] Study finds that PCI guided by FFR did not meet noninferiority for one-year outcomes compared to bypass surgery.
Retrieved 8-NOV-2021, from https:// abridged)