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Bypass, Angioplasty Similar in Survival

10 Years After Heart Procedures, Survival Rates Differ Little

Bypass Surgery, Angioplasty: Pros and Cons

Each procedure has downsides and benefits, the researchers found. Bypass surgery, Hlatky says, "is longer lasting, more durable, and gives more angina relief."

The downsides? "There is a higher risk of stroke during the procedure, and a longer recovery time."

Angioplasty is a ''simpler procedure and the recovery is faster," he says. Downsides: "It is very likely you will need a second procedure within six months. And there is not as much chest pain [angina] relief."

Strokes during the interventions occurred in 1.2% of bypass surgery patients and 0.6% of angioplasty patients. While 79% of angioplasty patients got angina relief at five years, 84% of surgery patients did.

Second Opinions

The new analysis is "very complete," says Kim A. Eagle, MD, director of the Cardiovascular Center and Albion Walter Hewlett Professor of Internal Medicine at the University of Michigan, Ann Arbor.

The study shows, he says, that if either procedure is considered appropriate for an individual patient, the decision can rest on patient attitudes and preferences.

While he finds some patients prefer to undergo bypass surgery, especially with its lower need to repeat, others want to avoid surgery and prefer angioplasty.

"If you are uncertain, get a second opinion," he says. "Ask hard questions." Such as: "What would be the downside of angioplasty in my situation? Any factors I have that might make you want to think about bypass instead of angioplasty? Is there a compelling reason to do anything? Is medical therapy equal to intervention [for me] in terms of preventing heart attack or death?"

Another expert, Curtis Hunter, MD, director of cardiothoracic surgery at Santa Monica-UCLA Medical Center & Orthopaedic Hospital in Santa Monica, Calif., says it is important for patients to realize the studies cover the least sick of heart disease patients, those for whom either procedure is considered appropriate.

"The two procedures are only shown to be equal in a very small subset and the healthiest portion of the population [with heart disease]," he says.

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