Bypass Surgery May Be Better Than Angioplasty for
TUESDAY, March 27 (HealthDay News) -- Patients over the age of
65 who have severe coronary artery disease fare better with bypass
surgery than with minimally invasive angioplasty, a large, new
Although there was no significant difference in mortality after
one year, patients who had undergone bypass surgery had a 21
percent reduced risk of dying after four years compared to those
who had received angioplasty, the researchers found.
"Here, individuals over the age of 65 had a survival benefit with surgery, so this may be a better choice for these individuals," said Dr. Nieca Goldberg, medical director of the Joan H. Tisch Center for Women's Health at NYU Langone Medical Center in New York City.
Goldberg was not involved with the study, which is to be
presented Tuesday at the American College of Cardiology annual
meeting in Chicago and simultaneously published in the
New England Journal of Medicine.
The trend in cardiology more recently has been to favor
angioplasty over surgery, explained study author Dr. William
During angioplasty, cardiologists insert a small "balloon" into
the blocked vessel via a catheter. Once in place, the balloon is
inflated to widen the vessel. The procedure can be done with or
without placing a stent, a wire mesh scaffold that keeps the vessel
Coronary artery bypass surgery involves grafting part of a
healthy vessel onto the blocked vessel to reroute blood flow,
"bypassing" the blocked part of the vessel.
But Weintraub, who is chair of cardiology at Christiana Care
Health System in Newark, Del., said he did not envision an
immediate sea change in clinical practice as the result of these
"People will give surgery another thought, especially for sicker patients," he said. "Rather than being a huge, huge change, this may switch it back a little."
Weintraub and his colleagues combined information from two large
databases which, all told, included about 200,000 patients, all
elderly and all with more than one blood vessel blocked.
About 86,000 underwent surgery and 104,000 had angioplasty. Of
those who had angioplasty, 78 percent received drug-eluting stents,
16 percent received bare-metal stents and 6 percent had no
Drug-eluting stents, considered state-of-the-art, ooze a drug
out into the artery that prevents scar tissue from building up.
Patients undergoing surgery tended to have more complications
such as diabetes, lung disease and heart failure, although the
authors did adjust for these factors.
Although the study was not a randomized, controlled trial --
considered the gold standard of medicine because those studies
randomly assign people to different treatments and compares them
with those who are untreated -- it had several advantages,
including the fact that it was looking at a "real-world" population
in real time, said Dr. Gregory Fontana, chairman of cardiothoracic
surgery at Lenox Hill Hospital in New York City.
This older population is very broad and represents probably the
largest proportion of individuals who need this type of treatment,
Fontana said, although the results probably can be extrapolated to
The U.S. National Heart, Lung, and Blood Institute has more on
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