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Stents vs Bypass surgery
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julieinoz58 posted:
I had a heart attack with stent in LAD on 12/30/10 and so far, so good with no more issues. I am also type 2 diabetic. I have been reading where studies show diabetics do better for the long haul with bypass surgery instead of stenting. I was also wondering if someone can have what I have had and then do fine for the rest of their lives? Just at a point where I am scared and questioning a lot of things.

Thank you
Reply
 
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James Beckerman, MD, FACC responded:
In the setting of a heart attack, a quick trip to the cardiac catheterization lab for a stent (if medically appropriate) still seems to be the right choice. The studies seem to tell us for people with stable blockages in the arteries (no heart attack) who are diabetic, that surgery tends to be superior as a treatment.

Moving forward, it will be important to exercise, eat healthfully, and take medications as directed - if you do have further symptoms, please let your doctor know! Take care.
 
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cardiostarusa1 responded:
Hi:

"I have been reading where studies......"

For reference

Bypass Beats Stents for Diabetic Heart Patients: Study

For a subset of heart patients who are both diabetic and have more than one clogged artery, bypass surgery appears to outperform the use of artery-widening stents, a major new trial finds.

http://www.newsday.com/news/health/bypass-beats-stents-for-diabetic-heart-patients-study-1.4188986

"Was also wondering if someone can have what I have had and then do fine for the rest of their lives?"

Mainly depends on how much damage the heart attack initially did, and, coronary stents (bare-metal or drug-eluting) are only a Band-aid or spot-treatment, as it doesn't address the disease process and what drives the progression.

It has been reported, that in some individuals, it's possible to halt or reverse atherosclerotic plaque in the arteries to some degree, through lifestyle changes, statin-therapy (**typically high-dose as seen in clinical trials), strict, uniquely-customized or highly-specialized diet (e.g., Ornish), exercise regimen, and stress management.

**Intensive Cholesterol Lowering With Atorvastatin Halts Progression Of Heart Disease, Cleveland Clinic-Led Study Shows

'REVERSAL' Trial

The REVERSAL trial, compared the highest doses available at the time of two popular statin drugs, pravastatin and atorvastatin....

"When we analyzed the results of REVERSAL, we realized that we had found an approach to coronary disease treatment that could literally stop heart disease in its tracks"......

http://www.sciencedaily.com/releases/2004/03/040309071559.htm
The bottom line

Coronary artery disease (CAD) is a lifelong unpredictable condition, requiring a continuum of care, as well as good doctor-patient/patient-doctor communication and understanding at ALL times.

Best of luck down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)



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Be well-informed

WebMD

Living With Coronary Artery Disease (CAD)

A chronic disease with no cure. When you have coronary artery disease, it is important to take care of your...

This is especially true if you have had an interventional procedure or...

Recognize the symptoms...

Reduce your risk factors...

Take your medications...

See your doctor for regular check-ups...


http://www.webmd.com/heart-disease/guide/living-with-heart-disease


Coronary artery anatomy

Starting with the left anterior descending (LAD), the most critical, next to the ultra-critical left main (LM).

http://www.heartsite.com/html/lad.html

_ . _

The coronary arteries are classified as so-called 'end circulation' since they represent the only source of blood supply to the heart muscle (myocardium). There is very little redundant (auxillary) blood supply (unless sufficient coronary artery collateral circulation has developed), which is why a blockage or blockages in these can be extremely critical.

_ . _

Good to know, for the primary and secondary prevention of heart attack and brain attack/stroke

Epidemiologic studies (EDS) have revealed risk factors (encompasses some new, novel or emerging) for atherosclerosis, typically affecting the carotid, coronary and peripheral arteries, which includes age, gender, genetics (gene deletion, malfunction or mutation) , diabetes (considered as being the highest risk factor), smoking (includes second and thirdhand), inactivity, obesity (a global epidemic, "globesity"), high blood pressure (hypertension), Low HDL (now questionable, according to recent studies) high LDL, small, dense LDL, RLP (remnant lipoprotein), high Lp(a), high ApoB, high Lp-PLA2, high triglycerides, HDL2b, high homocysteine (now questionable), and high C-reactive protein (CRP/hs-CRP).

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"Be a questioning patient. TALK to your DOCTOR and ASK QUESTIONS. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"

- Charles Inlander, People's Medical Society

.

It's your future......be there.

. .

WebMD/WebMD forums does not provide medical advice, diagnosis or treatment.
 
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julieinoz58 replied to James Beckerman, MD, FACC's response:
Thank you so much for your response. I am always looking for information and other opinions to help me live with my heart disease in a more positive and healthy way. However, I wish there was a magic pill to make the fear go away every time there is a little pain in the jaw or chest. (It is much better than before, but still there.) I was told by my doc that my ejection fraction is back up to between 50-55 and it was below 40. I quit smoking the day of my heart attack and I know have to exercise more and eat better so that is still a work in progress. I take all my meds as directed and keep all my appointments with my drs. I want to be around to watch my grandchildren grow up. My doctors say I am doing great and could go with no more problems, but I am still worried. This is scary stuff. Does a heart attack with a stent always lead to bypass surgery down the road?

Thank you
 
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billh99 replied to julieinoz58's response:
Does a heart attack with a stent always lead to bypass surgery down the road?

I am not a medical professional and I am not familiar with the difference caused by diabetes so take this with a grain of salt.

There are two different reasons for stents & bypass. And they are very different.

1. During a heart attack. That is an emergency.

2. When there are symptoms of blockage such as angina, shortness of breath, and fatigue. This is not an emergency and there is time to evaluate the options and plan the procedure.

Most of the time an MI is caused by vulnerable plaque that is in the range of 20-40% blockage. The covering is soft and it can rupture and clogs form to seal the wound. Much like a clog forms on cut skin.

Plaque that grows to 70% or more can slow the blood flow and cause angina, shortness of breath or fatigue. By the time that plaques reach that size they are hard and not prone to rupture.

One of the characteristics of statins is that they help stabilizing vulnerable plaque and thus reduces the chance of a rupture (MI).

It is not clear from the stories of the Freedom study, but reading between the lines it appears that the study was not done on people having an MI, but rather those with larger plaque blockages that where not emergencies.

Also the report says that they screened 33,000 persons and only 10% was eligible for the study. Apparently in the other cases whether to stent or bypass was clear cut.
 
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julieinoz58 replied to billh99's response:
Thank you for your reply BillH99. I appreciate you taking the time to share this information with me.


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