Should we wait for bypass surgery when stenting is available?
Doctors use two procedures to restore blood flow when blocked arteries reduce blood supply to the heart causing chest pain. Bypass surgery creates a new path around the blocked artery. Stenting opens the blocked artery by inserting a tiny mesh tube, called a stent. Randomized trials have shown better results for bypass surgery than stenting in treating multiple blocked arteries. However, these trials did not include patients who had to wait for many weeks before receiving their treatment.
Data access has been approved for a CIHR-funded project to examine results of bypass surgery and stenting done at various times after treatment decision (Principal Investigator - Boris Sobolev, a professor at the UBC School of Population and Public Health). The research team includes Dr. Guy Fradet, a cardiac surgeon at the Kelowna General Hospital, Dr. Simon Robinson, an interventional cardiologist at the Royal Jubilee Hospital in Victoria, Dr. Michael Law, an associate professor at the School, and Sean Hardiman, the provincial clinical director at Cardiac Services BC and a doctoral candidate at the School.
“In BC, where budget defines the number of scheduled procedures, patients often have to wait weeks for non-emergency bypass surgery. Stenting, on the other hand, is available practically without a delay,” explains Mr. Hardiman. "Evidence suggests that patients generally have better long-term survival and fewer myocardial infarctions after bypass surgery than after stenting. However, Prof. Sobolev's work showed that the therapeutic effectiveness of bypass surgery declines with increasing time to surgery.”
The investigators will determine whether results of bypass surgery performed within clinically acceptable times are still better than results of immediate stenting. This knowledge will help doctors decide how to treat blocked arteries when patients face delays for surgery.
For the project, Population Data BC will be linking records from Cardiac Services BC Registry (HEARTis), hospitalization records from the BC Ministry of Health and the BC Vital Statistics Agency files.