Angioplasty Equals Bypass Surgery for Heart Patients: Study

Survival rates virtually the same, but some people may prefer one option over the other.

By Ed Edelson
HealthDay Reporter
Tuesday, October 16, 2007; 12:00 AM

Copyright © 2007 ScoutNews, LLC. All rights reserved.

TUESDAY, Oct. 16 (HealthDay News) -- Someone with "mid-range" -- or intermediate -- coronary artery disease can use a new review of previous studies to help decide between angioplasty to open blocked arteries or bypass surgery to route new vessels around them, cardiologists say.

The long-term safety of the two procedures is just about the same, said study senior author Dr. Mark Hlatky, professor of health research and policy and cardiovascular medicine at Stanford University School of Medicine. Results for almost 10,000 patients from 23 clinical trials in the United States and Europe showed 98.2 percent survival for bypass surgery and 98.9 percent for angioplasty.

"But some people don't like the idea of major surgery and might want angioplasty," said Hlatky. "Others may want a more definitive treatment, with surgery more likely to relieve angina [chest pain] over a long period of time."

There was a lower chance of needing a repeat procedure for those who had surgery. Just under 10 percent of bypass patients had repeat procedures within five years, compared to 46.1 percent of those who had angioplasty without an implanted stent and 40.1 percent of those who had angioplasty with a stent.

But the reduction in repeat procedures came at the cost of increased risk of stroke. The stroke rate was 1.2 percent for those receiving bypass surgery versus 0.6 percent following angioplasty.

That increased stroke risk might make the difference for some people, said Dr. Deepak Bhatt, associate director of the Cleveland Clinic Cardiovascular Coordinating Center, since "many people would rather take the inconvenience of coming back rather than a higher risk of stroke."

Studies measuring quality of life found it was better for the three years following bypass surgery as compared to angioplasty. The difference disappeared after three years.

The point of the new study was to "give the full picture so that the patient and physician can come to the best decision about it," Hlatky said.

One important finding was that the overall survival rates for the two procedures were the same for people with diabetes. One previous study had found a significantly higher death rate for diabetics who had angioplasty, a result that immediately became controversial. The new study lessens the controversy but does not eliminate it entirely, Hlatky said.