They studied people with blockages in the left main coronary artery. It supplies blood to the left side of the heart muscle, which is the side that pumps fresh blood to the rest of the body. Current guidelines call for these patients to undergo bypass surgery.
"We focused on all-cause mortality and found no statistical difference between [angioplasty] and bypass surgery," says Seung-Jung Park, MD, director of interventional cardiology at Asan Medical Center in Seoul.
But angioplasty patients who received stents -- tiny wire mesh tubes used to prop open an artery -- were more likely than bypass patients to have to undergo procedures to reopen arteries that had reclogged, he says.
Still, the hope is that some patients with seriously blocked arteries may be able to avoid the more invasive bypass surgery, Park tells WebMD.
Angioplasty vs. Bypass
In angioplasty, a balloon at the end of a long tube is threaded through an artery in the groin. The doctor shimmies the probe up through the patient's leg and right into the arteries of the heart. The balloon is inflated at the spot where the vessel has narrowed, opening it.
To keep the vessel open, doctors often add a stent to the end of the balloon catheter. Some stents are coated with drugs to further reduce the risk an artery will reclog.
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.
For the new study, Park and colleagues analyzed data on 2,240 patients with left main coronary artery disease treated at 12 medical centers in Korea. Of these, 318 were treated with angioplasty and bare-metal stents, 784 were treated with angioplasty and drug-coated stents, and 1,138 underwent bypass surgery.
The findings were released at a meeting of the Society for Cardiovascular Angiography and Interventions being held in conjunction with the American College of Cardiology. They were simultaneously published online in The New England Journal of Medicine.
During three years of follow-up:
- The rates of death, heart attack, and stroke were similar in the two groups.
- Patients treated with bare-metal stents were nearly six times as likely to need a repeat procedure to reopen the affected vessel than those who underwent bypass surgery.
- Patients treated with drug-coated stents were about three times as likely to need a repeat procedure.
The next step is a clinical trial pitting bypass against angioplasty with drug-coated stents in patients with left main artery disease, Park says.
Bypass Still Treatment of Choice
Doctors are enthusiastic about the findings but stress that, for now, bypass surgery remains the treatment of choice for these patients.
"As you push a catheter through to the left main coronary artery, you're temporarily occluding most of the heart's blood supply," says American Heart Association spokesman Vincent Bufalino, MD, of Midwest Heart Specialists in Naperville, Ill. "The risks to the patients are considerable."
In the long term, there is also a risk of artery reclosure, or restenosis, even months or years after angioplasty, Bufalino tells WebMD. "If you're talking about the left main coronary artery suddenly reclosing, that could be a significant problem."
Patrick Serruys, MD, a professor of interventional cardiology at Erasmus University in the Netherlands, says that "many places in the world are now gaining quite acceptable results" using angioplasty in patients with left main coronary artery disease.
"But there's a long way to go before we can change clinical practice."
Cleveland Clinic's E. Murat Tuzcu, MD, moderator of a news conference that discussed the findings, says, "Left main [artery] disease has always been thought of as a surgeon's land. If confirmed in future studies, the implications are tremendous."