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Is stenting or surgery better for diabetics? New study provides answer

You may have heard about the new research showing that bypass surgery is better than stents for diabetics: In a Mount Sinai School of Medicine study of 1,900 diabetics with multi-vessel coronary disease, heart bypass surgery increased the five-year survival rate by 30 percent compared to the use of artery-widening stents.

I spoke with Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine at Stanford, who said that this study should settle the 17-year debate on bypass-vs-stent effectiveness with "compelling evidence."

In a New England Journal of Medicine editorial, Hlatky goes on to say that many of the stent procedures today are performed on the fly, during a diagnostic angiogram, with the same physician making the diagnosis, recommending the treatment, and performing the procedure. He feels that these new findings will result in a change for the better in clinical practice and will enable patients to be better informed about their choices.

This study should settle the 17-year debate on bypass-vs-stent effectiveness with 'compelling evidence.'

“Patients and their doctors need to allow time for discussions on which procedure should be done, based on outcomes that are important to them,” said Hlatky. “They need time to digest the information, discuss it with family members and members of the heart team, and come to an informed decision.”

It's worth noting that cost may be a factor in treatment discussions. Bypass surgery costs more than implanting stents, but because it results in fewer deaths and heart attacks, it is worth the front-end expense, said researchers on the cost-analysis part of the study. After factoring in the stent-related costs of new heart attacks and follow-on operations to re-open arteries, bypass surgery still costs about $3,600 more than the stent procedure over five years.

Previously: New test for heart disease associated with higher rates of procedures, increased spending and To stent or not to stent: not always an easy answer

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