Bypass Beats Angioplasty in Risky Patients -Report

Seriously ill heart disease patients do better if they get bypass operations than if they have their clogged arteries cleared out using angioplasty, according to a report published on Monday.

Seriously ill heart disease patients do better if they get bypass operations than if they have their clogged arteries cleared out using angioplasty, according to a report published on Monday. Patients who received the bypasses were half as likely to die within five years as those who got angioplasty, researchers report in the journal Circulation. “The sicker the patient, the more bypass surgery helped,” said Dr. Sorin Brener, an assistant professor of medicine at the Cleveland Clinic Foundation in Ohio. “The findings were somewhat surprising.” Brener said even when the angioplasty patients got stents — little mesh tubes to hold their arteries open — and advanced medications called glycoprotein IIb/IIIa antiplatelet drugs, bypass surgery saved more lives. The finding is surprising because bypass surgery is a major operation, involving cracking open the chest, stopping the heart, putting the patient on a heart-lung machine and then suturing in one or more new arteries to get blood in and out of the heart. Angioplasty is much less invasive. But arteries that are reamed out often clog back up, even when drugs and stents are used to prevent it. Brener and his colleagues examined survival records for 5,161 patients who had bypass surgery and 872 who had angioplasty at the Cleveland Clinic. About half the patients in both groups had diabetes or significant left ventricular dysfunction — which affects how much blood the heart is able to pump to the body. Overall, the survival rates looked similar — at first. Then the researchers factored in individual risk characteristics such as high blood pressure, smoking and diabetes. “Mortality rates for patients who underwent surgical bypass were almost half the rate of those treated with angioplasty who had similar cardiovascular risk profiles,” said Brener. (Source: Circulation: Reutersh Health News: May 2004)