Patients 'miss out on heart ops'

Stenting may need repeating

Thousands of patients with heart disease may be missing out on best care, an expert has warned.

Stents - small tubes - are used at least four times more often than bypass surgery to treat clogged arteries.

But cardiac surgeon Professor David Taggart argues in the British Medical Journal that a bypass can mean the best chance of survival for some.

He claims many patients are not offered a choice. The British Heart Foundation said both treatments were effective.

Stents versus grafts

In coronary artery disease, the arteries that supply the heart with oxygen and nutrients become narrowed by fatty deposits.

Revascularisation treatment, through stenting or bypass surgery, improves blood flow.

Three studies published in the BMJ compared the clinical and cost effectiveness of these treatments.

Significant numbers of patients who don't even get offered bypass operations as an option Professor Taggart

Two found that bypass surgery - where healthy arteries or veins are used to re-route blood around a blockage - was at least as effective, and probably more cost effective, than stenting when one coronary artery was blocked.

The third found any benefit of stenting over surgery was "too small to justify its additional costs" in patients with blockages in more than one of the heart's vessels.

Bypass can offer a better chance of long term survival for these patients with severe disease, work suggests.

Yet many cardiologists favour stenting and the procedure now outnumbers surgery at least four-fold, said Professor Taggart, professor of cardiovascular surgery at the University of Oxford.

Choice

He acknowledged that many patients also prefer stenting because it is less invasive.

But he said there was a bigger risk of persistent chest pain (angina) and reblockage with stenting, which can mean the procedure has to be repeated.

"I'm not saying that there are no patients that are suitable for stents, but in those with most severe disease, bypass grafting is a far more effective option.

"There are significant numbers of patients who don't even get offered bypass operations as an option," he said.

Professor Peter Weissberg, medical director at the British Heart Foundation, said both treatments were effective.

"People should be reassured that doctors will make sure they get the best possible treatment available to them," he said.

Coronary heart disease is a preventable but kills more than 110,000 people in England alone every year.

Just under 30,000 coronary artery bypass operations were carried out in the UK between 1993 and 2003.

Nearly 63,000 stenting procedures are now carried out annually in the UK.