June 1, 2005
Heart patients with two or more blocked arteries live longer if they have bypass surgery rather than angioplasty and stenting (a method of propping open arteries with wire-mesh devices), according to a study in the New England Journal of Medicine. This research could have major implications for heart patients since twice as many now have angioplasties to avoid the trauma of bypass surgery.
The researchers, offering a long-term comparison of death rates for the two procedures, examined 60,000 patients treated from 1997 to 2000 and found that 33 to 56 percent were more likely to die after angioplasty and stenting than after bypass surgery.
Specifically, they analyzed 37,212 bypass patients and 22,102 angioplasty patients in New York. The researchers found:
- Within three years of the procedure, angioplasty patients with stent insertions consistently had higher death rates than those who had bypass surgery.
- In the sickest group, the death rate was 15.6 percent for those who had angioplasty versus 10.7 percent for those who had bypass surgery.
"In just three years there were up to 540 'excess deaths' that might have been avoided if angioplasty and stent patients had had bypass surgery instead," said Dr. Edward Hannan, a contributor to the study.
"This is an unexpected finding, surgery [may] offer a benefit that we haven't picked up on," says Timothy Gardner, medical director of the heart and vascular center at Christiana Health Care System, Wilmington, Del. He adds that newer stents made with a drug coating to prevent the re-growth of tissue -- a common problem with angioplasties that forces additional procedures -- could help but would probably not affect the death rate.
In 2002, U.S. doctors performed 1.2 million angioplasties, about half with stents, while surgeons performed about 515,000 bypasses.
Source: Steve Sternberg, "For heart patients, bypass might be best," USA Today, May 26, 2005; based upon: Edward Hannan et al., "Long-Term Outcomes of Coronary-Artery Bypass Grafting versus Stent Implantation," New England Journal of Medicine, May 26, 2005.
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