Kevin Bainey conducted a new study that showed that stenting or bypass surgery, along with medication, resulted in a lower risk of death for patients with heart disease whose blood vessels were blocked in high-risk locations. Photo credit: Jordan Carson

A recent study by University of Alberta cardiologists at the Canadian VIGOR Center showed that a certain group of patients with stable ischemic heart disease had better outcomes with percutaneous coronary interventions (also called angioplasty with stenting) or bypass surgery and coronary artery medication compared to conservative ones Management achieved with drugs alone.

In a study published in the Journal of the American Heart Association, Associate Professor of Medicine and Academic Interventional Cardiologist Kevin Bainey and his team reviewed patient information from more than 9,000 Albertans with stable ischemic heart disease. These patients were outpatients, but had narrowed arteries in the heart and restricted the blood supply. They have also had other heart problems – known as high-risk heart anatomy – including blockages in critical parts of the heart’s blood vessels or restrictions in the left main artery of the heart.

The data showed that in patients with stable ischemic heart disease and high risk cardiac anatomy, coronary revascularization (stenting or bypass surgery) resulted in better health outcomes, including a reduction in the risk of death or heart attack, than a more conservative approach. After one year, the risk of death in patients with revascularization was 2.7 percent versus 6.8 percent in patients without revascularization.

“We firmly believe that coronary anatomy is an important prognostic indicator of health outcomes,” said Bainey, who is also director of the Adult Cardiac Catheterization and Interventional Cardiology Laboratory and Interventional Cardiology Scholarship Program. “In a patient who has a higher risk stress test and shows symptoms, we think it would be valuable to have a coronary angiogram to get a full picture, rather than just medication.”

Bainey’s study builds on the landmark ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) published in April 2020, which showed that an invasive approach such as stents or bypass surgery was not reduced in patients with stable ischemic heart disease the risk of death or future coronary events in the following years.

While Bainey said he would agree that there may be a role in conservative management in these patients, the high-risk anatomy was not addressed in the ISCHEMIA study. This prompted him to conduct further research to see if Alberta patients with high-risk anatomy could actually benefit from invasive approaches.

“Our results suggest that medical management is important, but there might be a small group that would benefit from revascularization and we need to find ways to identify that group of patients,” he said.

The results of his study also underscore the importance of cardiac anatomy in determining diagnostic and treatment options – something Bainey hopes more cardiologists will consider in treating patients with stable ischemic heart disease.

“The main message that physicians should know is that knowing anatomy is important,” Bainey said. “Whether you choose to have a CT scan or send patients for an angiogram, you need to define that anatomy and then make the decision to have revascularization or not.”

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More information:
Kevin R. Bainey et al., Long-Term Clinical Outcomes After Revascularization in High-Risk Coronary Anatomy Patients with Stable Ischemic Heart Disease, Journal of American Heart Association (2020). DOI: 10.1161 / JAHA.120.018104 Provided by the Faculty of Medicine and Dentistry at the University of Alberta

Quote: Stents or bypass surgery are more effective for stable, high-risk cardiac anatomy patients (2021, February 18), accessed February 18, 2021 from -effective-stable .html

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