The point of the new study was to "give the full picture so that the patient and physician can come to the best decision about it," Hlatky said.
One important finding was that the overall survival rates for the two procedures were the same for people with diabetes. One previous study had found a significantly higher death rate for diabetics who had angioplasty, a result that immediately became controversial. The new study lessens the controversy but does not eliminate it entirely, Hlatky said.
"We were kind of surprised by that result," Hlatky said. "No one had sat down and put all the data together. But even in this analysis, the number of such patients was fairly small. The issue will be decided by ongoing trials for patients with diabetes."
A decision about angioplasty versus bypass surgery is always easier to make outside the middle range of coronary artery disease looked at in these trials, both Bhatt and Hlatky said. "For high-risk coronary artery syndromes, revascularization [surgery] in general is the right thing to do," Bhatt said.
And angioplasty would be the procedure of choice for those whose condition could no longer be managed with drug therapy, Hlatky said. "We reviewed data from people in the intermediate zone of coronary disease," he said.
The analysis did not include angioplasties in which drug-coated stents, introduced several years ago, were used, rather than bare-metal stents. Use of the newer stents should not change the picture dramatically, Hlatky said.
Coronary artery disease and its treatments are described by the U.S. National Institutes of Health.
SOURCES: Mark Hlatky, M.D., professor of health research and policy, Stanford University School of Medicine, Stanford, Calif.; Deepak Bhatt,
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