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When Bypass Beats Angioplasty

For Complex Heart Disease, Surgery Often Best Treatment Choice

Angioplasty/Stents Still a Good Option

The current study results are similar to earlier studies in which Hannan and colleagues compared bypass surgery to angioplasty. But those studies looked only at bare-metal stents. The current study is the first to compare bypass to angioplasty using newer drug-eluting stents, which are less likely to clog.

However, drug-eluting stents are more likely than bare-metal stents to cause blood clots. Patients who get these stents now receive aggressive anticlot treatment -- treatment that was not routine during the time of the Hannan study.

This might have biased the results in favor of bypass surgery, notes Joseph P. Carrozza, MD, of Beth Israel Deaconess Medical Center, in an editorial accompanying the study.

Even so, Carrozza says the new results "are a sobering reality check for those who hoped the benefits of drug elution would level the playing field between [bypass surgery] and stents for patients with multivessel disease."

Does this mean all patients with multiple blocked arteries should have bypass surgery? No, Hannan says.

"When we talk about two procedures like angioplasty and bypass surgery, there is a big difference," Hannan tells WebMD. "In bypass surgery your chest is sawed open. You spend time in the hospital, and you don't feel well for a long time. After angioplasty, you go back to work the next day and feel fine."

There are medical reasons, such as dementia, that rule out bypass surgery for some heart patients. And Hannan notes that while bypass surgery has better long-term results for many patients, the short-term results are worse than for angioplasty.

"One reason to choose angioplasty and stenting is if patients just prefer not to get very aggressive surgery that will discommode them for many months," he says. "And the short-term adverse-outcome rate for bypass -- including the in-hospital mortality rate -- that is higher than for angioplasty. So if you have a strong need to survive for a short period of time, like a big event you want to be around for, that contraindicates bypass surgery."

Hannan says the next step for researchers is to find out whether patients with particular conditions do better with bypass surgery or with angioplasty.

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