The average person with multiple diseased arteries in the
heart does slightly better following coronary artery bypass surgery than after
having stents inserted, a new study suggests, but the optimal procedure varies
Researchers found slightly more heart patients survived at
least five years after bypass surgery – 74%, versus 72% of those who had a stenting
procedure, known as angioplasty. However, people who had no diabetes or heart
failure and were non-smokers tended to have better outcomes with angioplasty
than with more invasive surgery, the study team reported Monday in the Annals
of Internal Medicine.
"It's good to say, 'On average people do better with
this drug or this procedure,'" said Dr Mark Hlatky, a healthy policy and
cardiovascular medicine researcher at Stanford University in California.
"But if we could only target the people who would get the most benefit,
we'd probably make better decisions and maybe save money," he said.
Researchers looked at
For their study, Hlatky and his colleagues tracked the
records of 105 156 people on Medicare, the government health insurance program
for the elderly, who had bypass surgery or received stents between 1992 and
2008. Patients from each treatment group were matched by age and the year they
had their procedure.
The researchers calculated the average patient lived 19 days
longer after bypass surgery than stenting. People with diabetes, heart failure
and peripheral artery disease, as well as those who smoked, were especially
likely to benefit from bypass surgery.
But the rest of heart patients - as many as 41% - were
predicted to do better after angioplasty, they found. Bypass surgery involves
grafting a healthy blood vessel around a blocked one, so blood
"bypasses" the unhealthy vessel. For a stent procedure, a small mesh
tube is inserted into the blood vessel after it's opened with a balloon-tipped
Patients with diabetes fare better
The results are consistent with other recent research
suggesting people with diabetes and multiple clogged arteries fare better after
undergoing bypass surgery than after receiving drug-coated stents "The
first question is whether you need something done at all, (or) whether drugs
alone are enough," Hlatky said.
questions is, once you think you do need to go ahead and drug therapy is not
enough - either because symptoms are too bad or the patient is high-risk - then
you can decide between bypass surgery and angioplasty."For people who have
only one clogged vessel, angioplasty is typically fine, Hlatky said. "On
the other end if there's very, very severe coronary disease in lots of places, most
of the time patients go straight to surgery," he added.
It's in the middle where patients and doctors can use
studies like this one to make more informed decisions about what treatment
might be best for them, Hlatky said. According to the Healthcare Blue Book,
bypass surgery runs for about $64 000 (R589 926), including the hospital stay.
Because angioplasty requires fewer days in the hospital, it typically costs
less than half that.