Bypass, Angioplasty Similar in Survival
10 Years After Heart Procedures, Survival Rates Differ Little
Oct. 15, 2007 -- The survival rates 10 years after coronary artery bypass
surgery and angioplasty are similar, according to a new analysis of nearly
10,000 heart patients.
Five years after the procedures, 90.7% of the bypass patients and 89.7% of
the angioplasty patients were still alive, says Mark A. Hlatky, MD, senior
author of the analysis and a professor of health research and policy and
professor of medicine at Stanford University School of Medicine in Palo
"Although only a few of the studies followed patients more than five
years, there was no appreciable difference [in survival] at 10 years," he
Complications do differ between the two procedures, however.
Hlatky and colleagues stress that their analysis only applies to a select
group of heart patients: those for whom either procedure would be considered a
For patients who are eligible for either heart intervention, "either is
feasible," Hlatky tells WebMD.
The report is released early online and will be published in the Nov. 20
issue of the Annals of Internal Medicine.
CABG vs. Angioplasty
The researchers evaluated the results of 23 clinical trials in which 5,019
patients were randomly assigned to get angioplasty with or without stents, also
called catheter-based percutaneous coronary intervention or PCI, and 4,944 were
assigned to get coronary artery bypass graft surgery, also called CABG.
The average age of patients was 61; 73% were men.
Heart Intervention Procedures
In angioplasty, interventional cardiologists push a balloon-like device into
the coronary arteries and inflate the balloon to widen the vessel. An
expandable wire mesh tube called a stent may be inserted to keep the vessel
open. Some stents are coated with drugs meant to help prevent the artery from
clogging up. In 2005, about 645,000 angioplasty procedures were done in the
In bypass surgery, cardiac surgeons harvest a segment of a healthy blood
vessel from another part of the body and use it to bypass the clogged artery or
arteries, rerouting the blood to improve blood flow to the heart. About 261,000
bypass procedures were done in the U.S. in 2005.
CABG vs. Angioplasty: Findings
Besides similar survival rates overall, the researchers found no significant
survival differences between the two procedures for patients with diabetes,
although earlier research had seemed to favor bypass surgery. But Hlatky says
ongoing studies looking more closely at diabetic patients will yield a more
Similar numbers of patients suffered heart attacks within five years of the
procedures. While 11.9 of those who got angioplasty had a heart attack within
five years, 10.9% of those who got bypass did.
Repeat procedures were more common in angioplasty patients. While 46.1% of
angioplasty patients who didn't get a stent needed repeat procedures, 40.1% of
those who got a stent did. But just 9.8% of surgery patients needed another
The study didn't include information on drug-coated stents, which have been
found in some studies to increase risk of blood clots and other problems.