For the “Widow Maker”---Stent and Surgery are Equally Safe and Effective By Paula Rasich Reviewed by Elizabeth Klodas, MD, FACC (CardioSmart) Each year, many people with coronary artery disease get stents, tiny mesh tubes that hold clogged arteries open.

In the SIMA (Stenting versus Internal Mammary Artery) Trial, a multi-center European study of 121 heart patients, Jean-Jacques Goy, MD, and colleagues from the University Hospital in Lausanne, Switzerland and elsewhere compared the long term safety and effectiveness of bare-metal stents (stents that are NOT coated with any specific medications) with CABG.   The study specifically looked at patients with narrowing in the first part of the left anterior descending (LAD) coronary artery.   The LAD coronary artery usually supplies a very large part of the heart muscle, so narrowings in this artery are especially worrisome.  Indeed, a narrowing in the first part of the LAD is commonly referred to as “the widow maker.”

In the trial, 59 patients underwent bypass surgery and 62 were treated with angioplasty plus a bare-metal stent. A year later, researchers found that those who received stents were more likely to experience reblocking and require a second procedure than those who had undergone surgery. After 10 years, they found that 10% of patients in each group died or had a heart attack.

“The only difference between stenting and grafting is the need for additional revascularization one year after the intervention,” says Dr. Goy.

Still, no matter which procedure a patient undergoes, problematic plaque often reforms inside artery walls.  Heart experts believe that statins, cholesterol-lowering drugs which also have anti-inflammatory and anti-oxidant effects, help combat this problem. In this study, most of the patients were also treated with drug therapy. And researchers found that after 10 years the need for another procedure to open blocked arteries was similar in both groups at 5%.

“Most of our patients who were treated with statins did not develop new lesions,” says Dr. Goy.  “That means if patients get good preventive medical treatment, the progression of the disease will probably be under control.” 

To find the right approach for you, discuss the specifics of your condition as well as all treatment options with your cardiologist. “Even for patients who have single vessel disease, surgery exists and is an option because the long term results are good,” says Dr. Goy. “And for some patients, and for some lesions, surgery is better.”  It should be noted that the study did not include drug coated stents (sometimes called drug eluting stents or DES).  These stents have been shown to reduce re-narrowing at the site of treatment, especially in the near term.

The study is published in the September 2, 2008 issue of the Journal of the American College of Cardiology. 

Sources:

Goy JJ et al.  10-Year Follow-Up of a Prospective Randomized Trial Comparing Bare-Metal Stenting to Internal Mammary Artery Grafting for Proximal, Isolated De Novo Left Anterior Coronary Artery Stenosis.  The SIMA (Stenting versus Internal Mammary Artery) Trial.  Journal of the American College of Cardiology, 2008.

Jean-Jacques Goy, MD, Professor of Cardiology, University Hospital in Lausanne, Switzerland.