Medical professionals have been opting to use stents over bypass surgery for a while. Not only because there are fewer risks to the patients, but because the costs (before insurance) are dramatically different. Should you not have insurance, you can expect the insertion of a stent to run you about $ 41K, but bypass surgery can run about $ 170K. Now, these are not your out-of-pocket costs, because there are negotiated rates for those covered by insurance, but you can bet that it still costs you more for bypass surgery, even with insurance.
But, it turns out that there are some pretty good reasons to provide a significant portion of these 700,000 patients treated annually with bypass surgery, nevertheless. (There is a higher incidence of stroke [5.2% v. 2.4%] for patients who undergo bypass surgery, though.) Yes, even the insurance companies will have to recognize this fact, now that the research is published. (There have been other studies that provided similar results, but the “feeling” was they they compared older generation stents, had too small a population base, or compared angioplasty and not the use of stents.)
Dr. Valentin Fuster headed up the Freedom (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) Trial. (His co-investigators included 27 other MD’s, MD/PhD’s, and MPH at his affiliation, Mount Sinai School of Medicine, as well as other world-famous healthcare facilities across the globe- plus the National Institutes of Health). The group presented their results at the American Heart Association meeting on 4 November, with simultaneous publication of the study in the New England Journal of Medicine.
The results indicate that patients with diabetes (about 1/4 of those 700,000 annual subjects) fare much better with bypass surgery (more likely to survive or avoid future attacks). Diabetic patients have different vessel blockage than other patients; it seems that the plaque that occludes blood flow tends to be more diffuse than those who don’t suffer from diabetes. As such, these plaques don’t lend themselves to “fixes” with a single stent.
Fuster et. al. examined 1900 diabetic patients who had blockages of 70% or greater in more than one epicardial (heart) vessel. These folks were assigned randomly to be provided either stents or undergo bypass surgery. 26.6% of those who received stents either suffered a stroke, heart attack, or died, compared to 18.7% of those who underwent the bypass surgery. Moreover, those who received stents were twice as likely to undergo additional procedures for blockages. 
It should be noted that the risk for both procedures is inverted for the first few months, a factor which is more related to the complications arising from open heart surgery. But, by the end of the two year survival period and throughout the five years of the study, the surgery procedure clearly provided better patient outcomes.
Wow. I cannot believe those prices. No wonder the USA is considered a third-world country when it comes to health care. If those figures don’t instantly make everybody petition Congress to give the insurance companies the heave-ho and replace them with a single payer system, nothing will.
David Leonhardt recently posted..Apparently, FaceBook does not bring happiness after all – study
Yes, the costs for health care in America are astounding. And, that’s not including the recognized waste in the system- which, if we took care of 1/2 of it- would cut our deficit spending in half!!! That was one of the reasons for trying to reform health care (but, we reformed health care insurance, instead), David!
My sister had a triple by-pass done over 1 1/2 years ago. I’m glad she did even though she was miserable for a long time. She still isn’t up to her old self, but it was amazing how quickly she was able to breathe better, her color improved and even her thinning hair got a little thicker. Thanks for the article.
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Yup, Ann. The first three months ARE a b..h… But, the end results- depending upon the nature of the blockage- are superior with bypass, when compared with stents. Of course, our pocketbooks may need a bypass, as well…
My father died in cardiac ICCU, after…extensive surgery on his heart, and the doctors told us that if he lived he would have to have further surgery…bypasses. Now, we know how that stories ends…but not long, I want to say…days after he passed and mom got the bill, and it was…nearly 200K. Which, being newly widowed you might equate to terrorist activity. Jokingly, I have always thought if you lose the patient the surgery should be free. But that experience, and the fact that my late husband’s chemo was like 30K a pop…even with insurance on both men leaves massive bills. People wonder why I’m for universal health care. Anyway, I’m just rambling Roy, and I’m sorry for that…just wanted to comment and thank you for the information!
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I’m for universal healthcare, too, Lisa. But, that does mean- yes, Mr. Anti-Obamacare- that there needs to be cutoffs on what we will cover. (You can call it a death panel, I call it giving the best care to the most people. One is always welcome to pay out of their own pocket.)
Thanks for the article Roy, I’m had private heart surgery last year and I’m really happy with the results of the surgery
So glad to hear that things worked out well for you, Sarah-Jane. May your recovery return you to full vitality.
Thanks for sharing AND visiting.