A disagreement over how to classify a heart attack caused some European physicians to withdraw from the results of a new study that concluded bypass surgery and stents are similarly good at preventing deaths from heart disease when a major heart artery is blocked.
Stents-tubes that reopen a narrowed artery-are becoming increasingly popular as patients recover more quickly than after surgery. Whether stenting is as successful as bypass surgery in the long term when the left main coronary artery is blocked, concerns have lingered.
The methods were equally safe as researchers looked at deaths from heart disease alone. With stenting and surgery, heart attack rates were similar as well. BBC Newsnight said research obtained from EXCEL on December 9 reveals that if something called the “Generic Standard” is used to describe a heart attack, receivers of the stent are 80% more likely to have one.
EXCEL researchers used a common model instead of the standardized definition to describe a heart attack defined by the Cardiovascular Angiography and Intervention Society. According to the response from the EXCEL team, everyone involved in EXCEL, including cardiac bypass surgeons, felt the Universal Definition “Was not suitable” to compare the two techniques.
For stent and bypass cases, it describes heart attacks differently, This makes it difficult to compare the practices.
The Universal Definition requires a highly sensitive blood test to check for heart muscle injury, a test that is so sensitive that it can pinpoint minor damage caused by the treatment itself. The check on patients undergoing stenting or bypassing surgery is not even performed by many doctors.
The higher death rate in the stent group was largely due to non-heart-related causes, especially cancer and infections that appeared several years after stenting or surgery, according to EXCEL researchers.
“No attempt was made to mask meaningful data,” the researchers said, and EACTS withdrew from the guidelines “Without even asking for clarification from the EXCEL study group.” Researchers also said that because statistics used to measure heart attacks under the Universal Definition were not regularly obtained from patients in the sample, any results released to the BBC appearing to indicate heart attack rates under the Universal Definition “are not reliable.