Bypass surgery bests angioplasty for long-term survival
March 27th, 2012
09:38 AM ET

Bypass surgery bests angioplasty for long-term survival

Older people with heart disease who undergo non-emergency procedures to restore blood flow to their heart generally have better long-term survival odds with bypass surgery than with angioplasty, according to new research published online in the New England Journal of Medicine.

The study included about 190,000 men and women over age 65 who had bypass surgery or angioplasty - a far less invasive procedure - between 2004 and 2008. One year after the procedures, the survival rates for both groups hovered just under 94%. At the four-year mark, however, 84% of the bypass patients and 79% of the angioplasty patients were still alive.

The difference in survival rates was consistent across several key subgroups of patients, including men and women, high- and low-risk patients, and those with and without diabetes, the study found.

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"There's been a shift over the last two years to PCI, and probably we ought to rethink that a little bit and reconsider cardiac surgery," says lead author William S. Weintraub, M.D., a cardiologist with the Christiana Health System in Newark, Del. Weintraub presented his findings today at the annual meeting of the American College of Cardiology, in Chicago.

Bypass surgery involves taking a blood vessel from elsewhere in the body and grafting it to the heart to bypass a blocked artery. Surgeons must cut open the patient's breastbone and spread apart the ribs to access the heart, and a full recovery can take up to 12 weeks, including an initial one-or two-day stint in intensive care.

Angioplasty, also called percutaneous coronary intervention (PCI), has become an increasingly common alternative to open-heart surgery largely because the procedure is less taxing, Weintraub says. A balloon-tipped catheter is threaded into the heart via an incision in the groin or arm, and the balloon is then inflated to flatten artery blockages. Patients don't need general anesthesia, and they typically go home the next day.

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Several randomized controlled trials have compared the effectiveness of angioplasty and bypass surgery, but most looked at highly specific subgroups of patients, the authors note. The new study was designed to "better reflect real-world practice," they write.

How do cardiologists and surgeons decide which procedure is best for a certain patient? Weintraub says a wide range of factors come into play, including the distribution of blockages within the heart, the severity of the patient's symptoms, and his or her overall health. Very elderly, frail patients aren't good candidates for bypass surgery because the procedure puts such a huge strain on the body, for instance.

At the same time, the accumulating evidence suggests that bypass surgery may be preferable in patients with more advanced heart disease. "The sickest patients would seem to do better with surgery," Weintraub says. "The hard part is, what's the dividing line."

Health.com: Know your heart attack risk factors 

Identifying that line is a complex process, so the new findings may not be relevant for every heart patient. Nor do they mean bypass surgery is the better option for everyone.

"This is a decision that has to be made one patient at a time," Weintraub says. "We don't make that decision to send somebody for coronary surgery lightly. That's a big decision."

Copyright Health Magazine 2011

soundoff (25 Responses)
  1. Tom Jones

    Aspirin beats angioplasty and stenting. But wait, I forgot! You can't charge 50K for an aspirin yet, can you?

    Angioplasty and coronary artery stents were proven less than, and at best equal to medical therapy, it's been proven for a couple decades, but cardiologists and their stent making friends keep pushing them on folks that don't need 'em, all for money.

    But until insurance companies wise up (and they don't have a reason to, they make money of us too), our society will continue to subsidize the lifestyles of rich and shameless cardiologists and their friends at Johnson&Johnson, et, al....

    "You think healthcare is expensive now?, Wait till it's free!"

    March 27, 2012 at 11:38 | Report abuse | Reply
    • Carmliv

      The greatest surgical threat in America across all specialties is greed!

      March 27, 2012 at 19:56 | Report abuse |
  2. CANand

    Actually, the COURAGE trial to which you are referring, showed no reduction in mortality with angioplasty plus optimal medical therapy compared to optimal medical therapy alone, but did show a significant reduction in symptoms (angina). For this reason, stents have never been offered as a way to prevent heart attack, but they are used when medical management is no longer able to control symptoms.

    This study tells us that in some patients, bypass may actually have survival benefit, while angioplasty is still only for symptom control.
    With reference to acute MI, the SHOCK trial showed that revascularization with PCI does have mortality benefit at 6 and 12 months following heart attack.

    March 28, 2012 at 13:03 | Report abuse | Reply
    • shikha

      Guys u can heal ur heart without surgery with #eecp treatment

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      September 1, 2015 at 06:25 | Report abuse |
  3. Janardhan

    My dad aged 66 having mild diabetes was diagonised with triple vessel coronery artery disease based on the Angiogram. He was advised surgery. To be doubly sure, I checked with other cardiologists and cardiac surgeons and the same angiogram seems to suggest different things to different cardiologists/surgeons.

    1) None of them is clear about the block percentage. Each of them vary differently. Some say 70% and some say 40% only.
    2) Some doctors said just a stent ( max 2 ) is good enough and some say surgery and some say since the major vessel is fine, just medication is good enough. But the best part is that each of them is very dogmatic about their choice.

    All in all it is left to individuals patients to research and come to conclusion than based on firm solid recommendation from doctors. We are in two minds as whether to go to surgery or plasty.

    April 3, 2012 at 06:47 | Report abuse | Reply
  4. David

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    April 7, 2012 at 18:11 | Report abuse | Reply
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      September 1, 2015 at 06:27 | Report abuse |
  7. Jerricac Mitjab

    The following time I learn a blog, I hope that it doesnt disappoint me as a lot as this one. I mean, I know it was my option to learn, but I truly thought youd have something attention-grabbing to say. All I hear is a bunch of whining about something that you might repair if you happen to werent too busy in search of attention.

    July 27, 2012 at 03:02 | Report abuse | Reply
  8. linda sherman

    I think Dr.Gupta should have mentioned a word about the causes. Smoking and bad diet are very important causes and most patients ignore these basics. In fact smoking is one of the top causes of Heart attack. We should all educate our loved ones about these. Source : http://www.medicalsingapore.com/Angioplasty.html

    December 12, 2012 at 14:27 | Report abuse | Reply
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      September 1, 2015 at 06:33 | Report abuse |
  9. Bora

    Very informative article. Patients who have a coronary artery bypass surgery need regular monitoring from a physician. Among the changes in monitoring are five years after the surgery the addition of a regular cardiac stress test even when there is no change in the patient's status. Patient usually go on to live normal and healthy lives. Source : Coronary bypass

    December 19, 2012 at 16:39 | Report abuse | Reply
  10. Bora

    Very informative article. Patients who have a coronary artery bypass surgery need regular monitoring from a physician. Among the changes in monitoring are five years after the surgery the addition of a regular cardiac stress test even when there is no change in the patient's status. Patient usually go on to live normal and healthy lives. Sourced from : http://www.india4health.com/coronarybypass.html

    December 19, 2012 at 16:40 | Report abuse | Reply
  11. Bora

    A very informative article. Thanks for sharing your experience with fellow readers. Sometimes a person with a higher level of coronary artery disease (CAD) may undergo fewer bypass grafts due to the lack of suitable 'target' artery vessels. A coronary artery may not be suitable for bypass grafting if it is small in size. Source: http://www.india4health.com/CoronaryBypass.html

    April 25, 2013 at 13:38 | Report abuse | Reply
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    I wants to know that which strain is best for the angioplasty,i.e.Indian strain worth rupees 1,18,000 or American strain worth rupees 2,30,000. We don't have that much budget please suggest something. It's too urgent. My grand father had heart attack. There is 90% of blockage in left side & 85% of blokege in right side.please suggest me something.

    July 15, 2016 at 22:11 | Report abuse | Reply
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