Last week, a study published by The New England Journal of Medicine suggested that patients undergoing a cardiac bypass procedure had better survival and re-intervention results over patients who received a stent.
As you might imagine, this news raises concerns for investors and analysts who wonder what the future now holds for stent makers like Johnson & Johnson
This is the best study I've seen since stenting become commonplace in the late '90s. But here's the thing -- the news isn't completely "new." Anecdotal evidence existed before now suggesting that bypass procedures offered better success rates -- particularly when more than one diseased vessel was involved.
Put simply, coronary bypass procedures are generally a very good way of dealing with the problem -- re-clogging of the artery is less of a problem, and there is less need for follow-up procedures. What's more, now that bypass procedures can be performed without a heart-lung machine, recovery times are shorter and complication rates are lower.
So is this the death knell for stents? Not if cardiologists have anything to say about it.
Remember, cardiologists use stents and cardiac surgeons do bypasses, so there is something of a competition between the two for procedures and payments. Now, I'm not suggesting that a cardiologist would jeopardize a patient's health just to make money, but if all you're carrying is a hammer, as the old saying goes, pretty soon you start seeing a lot more nails. Couple this with the fact that stent procedures can be very profitable for hospitals, and you have a clear economic incentive to continue using stents.
Let's also not lose sight of a few other points. First, this study concerned only multi-vessel disease. Second, while bypass patients saw lower mortality rates than stent patients did, results were still pretty fair in the stent group. Third, bypass procedures are more expensive, and whether we like it or not, health insurers are going to evaluate this study in terms of risk/benefit relative to cost. Fourth, this study was conducted before drug-coated stents hit the market. And finally, while recovery times and complication rates have improved for bypass procedures, it's still a tougher procedure to go through than stenting.
I'd be amazed if this news results in any kind of obituary for stenting. It might be a strong message that aggressive cardiologists should hand over riskier and more complex cases to surgeons for a bypass, but I really don't see it as a condemnation of the use of stents in simpler cases with less severe disease.
In other words, reports of the death of stents might be just a tad exaggerated today.
For more on stents and cardiology companies:
- A Second Opinion on Medtronic
- Stent Wars 2: The Market-Share Menace
- Will Anybody Love Angiotech?
- SurModics' Profitable Ride
A quick note to Medtronic investors -- when I said in an earlier piece that Medtronic does not yet dominate the spine business, that was meant to be a relative statement compared with what I believe the company is CAPABLE of doing with just a bit more effort.
Fool contributor Stephen Simpson has no financial interest in any stocks mentioned (that means he's neither long nor short the shares).