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Bypass Surgery More Reliable Than Angioplasty

Posted on: Tuesday, 2 September 2008, 09:20 CDT

New findings presented Monday at the European Society of Cardiology meeting in Munich suggest that patients who have angioplasties are twice as likely to require another procedure within a year than those who have bypass surgery.

"If you don't want to have another heart operation for at least a decade, you should pick the surgery," said Dr. Heinz Drexel, professor of medicine at the University of Innsbruck in Austria and spokesman for the European Society of Cardiology. Drexel was not connected to the research.

"But that means you have to have your chest cracked open," he said.

Bypass surgery and angioplasty are the two primary options doctors and patients face for clearing out clogged arteries. During a bypass, doctors must reroute blood vessels around blockages.

Angioplasties are non-surgical procedures in which doctors use a balloon to flatten the blockage, leaving a stent to prop the artery open.

Angioplasties have become increasingly popular in recent years.

European doctors compared the effectiveness of open-heart surgery versus angioplasty in a trial of more than 3,000 patients in Europe and the United States. They excluded patients who had acute heart attacks and included those who had single and multiple vessel blockages.

About a third of the patients had medical conditions that required surgery. The remaining patients were randomly assigned to receive either surgery or an angioplasty. Patients who got an angioplasty needed an average of nearly five stents.

One year after surgery, doctors noted that patients who had bypass surgery had a lower death rate, 3.5 percent, compared to those who had angioplasties, 4.3 percent.

Nearly 14 percent of patients who had an angioplasty required a second procedure within one year, compared to about 6 percent of surgery patients.

But patients who had surgery had about a 2 percent stroke risk versus nearly zero risk for patients who had an angioplasty. Doctors said that any surgery had an inherent stroke risk, compared with an angioplasty.

In January, a study published in the New England Journal of Medicine found that bypass surgery was still the best option for heart patients with more than one clogged artery.

"Surgery still comes out as the winner in a head-to-head trial," said Dr. Douglas Weaver, president of the American College of Cardiology, who was unconnected to the research.

"This comes down to a conversation with patients and making sure they know that with an angioplasty, there will be a higher rate of revascularization," he said, referring to the need for repeat procedures.

"You invest more in terms of recuperation with surgery," said Dr. Tim Gardner, president of the American Heart Association. "But the advantage is durability."

In 2006, studies began to emerge showing that patients with the drug-coated stents were more likely to develop potentially fatal blood clots months and even years after they were implanted.

Stent sales plummeted and doctors have become more wary of their use, saving them only for certain patients with no other options.

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On the Net:

• European Society of Cardiology

Source: redOrbit Staff & Wire Reports

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