Bypass, Angioplasty Similar in Survival

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 Alto.

"Although only a few of the studies followed patients more than five years, there was no appreciable difference [in survival] at 10 years," he says.

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 reasonable choice.

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 U.S.

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 definitive answer.

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 procedure.

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.