Bypass surgery better than angioplasty for certain heart patients

LONDON - Researchers at Stanford University School of Medicine have found that for the treatment of patients suffering from multi-vessel coronary artery disease, who have diabetes, and for patients older than 65, heart bypass surgery is a better option than angioplasty.

For the study, the researchers worked with investigators from 10 different clinical trials around the world for 3 years, and pooled enough individual patient data to compare the effectiveness of coronary artery bypass surgery with the less-invasive angioplasty procedure on specific groups of patients for the first time.

The study looked at raw data from almost 8,000 research subjects.

It showed that for patients suffering from multi-vessel coronary artery disease, who had diabetes, and for patients older than 65, coronary artery bypass graft might be a better treatment choice than percutaneous coronary intervention (commonly known as coronary angioplasty).

PCI is the technique of using balloons or stents to widen narrowed or obstructed blood vessels.

However, in patients 55 years and younger, PCI may be the best choice.

“Whether you have diabetes really makes a big difference. Over several years there’s a much lower rate of death with bypass surgery. The patient’s age was the other major factor that affected outcomes, and this was a bit of a surprise,” Lancet quoted lead investigator Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine at Stanford as saying.

It was found that for patients with diabetes, the mortality rate after a five-year follow-up was 12 percent for those who had bypass surgery, compared with 20 percent for the angioplasty procedure.

Among patients older than 65, the mortality rate was 11 percent for those who had bypass, compared with 15 percent for those who had angioplasty.

“This is the kind of research we’re hoping to have more of so that clinicians and policymakers and patients can make informed decisions,” said Douglas K. Owens MD, senior investigator at the Veterans Affairs Palo Alto Health Care System and professor of medicine at Stanford.

The study supports previous findings that long-term mortality is similar after bypass or angioplasty for the average patient with multi-vessel coronary artery disease.

However, the new study goes one step further to check whether this overall result is also true in most patient subgroups, such as women, smokers and patients with hypertension.

“We’re not really sure of why surgery was better for these groups of patients. It’s a very important and provocative observation that needs to be investigated further,” said Hlatky.

The study has been published online in The Lancet. (ANI)

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