"The debate over coronary bypass surgery http versus stenting goes back decades. Studies have been inconclusive but doctors and patients have voted with their feet in favor of the lessinvasive procedure  clearing clogged arteries and propping them open with tiny scaffolds called stents. U.S. doctors do at least two stenting procedures these days for every coronary bypass operation. Now the biggest collection of cases so far comes out in favor of surgery on the allimportant question of mortality. Four years after the procedure patients over  who had coronary artery bypass surgeries called CABG or cabbages were almost  percent less likely to die. Put another way  percent of stented patients had died after four years compared with  percent of surgery patients. Is that a big difference Well the studys lead author tells Shots that it might be enough to tip the balance a little bit but not overwhelmingly so. The National Heart Lung and Blood Institute which funded the study with new stimulus money from the American Recovery and Reinvestment Act is more bullish on the implications. We would hope a study as powerful as this one will inform decisionmakers to rethink the direction theyre going in the NHLBIs Dr. Michael Lauer httppublic.nhlbi.nih.govNewsroomhomeShowBio.aspxPID told Shots. He says its been worrying that so many doctors have been opting for stenting over surgery. Article continues after this message from our sponsor Study author Dr. William Weintraub http chief of cardiology at Christiana Care Health System in Newark Del. is presenting the data at the annual meeting of the American College of Cardiology in Chicago. The study also appears online http_home in the New England Journal of Medicine. It draws on data from more than  patients across the nation who underwent CABG operations and nearly  patients who had coronary stenting. They had blockages in either two or three coronary arteries but did not require emergency procedures. Although the prosurgery outcome is not a gamechanger Weintraub says it might cause some doctors and patients to consider surgery. And he says it supports those who now opt for CABGs. Its a very big deal to recommend coronary surgery to patients Weintraub says. I think doctors work very hard to weigh whats best for their patients. When doctors recommend surgery these data suggest that that decision is a good one. But Dr. Laura Mauri http_teamLaura_Mauri says in an accompanying editorial http_home that the new study cant settle any debates. Only studies that randomly assign comparable patients to surgery or stenting can do that. Mauri is an interventional cardiologist  i.e. a specialist who does coronary stenting  at Brigham and Womens Hospital inBoston. Weintraub notes its very difficult and expensive to do randomized studies on this question  and to make the comparison groups truly comparable. And while such a study is being done the technology especially stenting technology changes. That can call into question the ultimate relevance of the findings. So the new data may be the best that doctors and patients in this situation can expect for the foreseeable future."