Bypass, Angioplasty Similar in Survival
10 Years After Heart Procedures, Survival Rates Differ Little
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.
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.
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.