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Diabetics and Elderly May Fare Better With Bypass
Date:3/20/2009

Study finds that for some groups, survival odds after angioplasty are not as great

FRIDAY, March 20 (HealthDay News) -- A major international study pinpoints which people with major heart artery blockages would be better off having bypass surgery than artery-opening angioplasty.

"Bypass surgery is preferable for people with diabetes and older patients," said Dr. Mark Hlatky, professor of health research and policy and cardiovascular medicine at Stanford University and lead author of a report published online in The Lancet. "We used 65 as the cutoff point and, as age went up, so did the benefit of bypass surgery."

Hlatky led a group that looked at survival data on almost 8,000 people treated in 10 trials worldwide. Overall, the death rate over an average of nearly six years was almost the same for those who had bypass surgery (15 percent) and those who had what is formally called percutaneous coronary intervention, or PCI (16 percent).

But analysis showed that people with diabetes were 30 percent less likely to die if they had bypass surgery rather than PCI. People 65 and older who had bypass surgery had a mortality rate of 20 percent, compared with 24 percent for PCI.

The study is a prime example of the relatively new approach called comparative effectiveness research, Hlatky said. Most controlled trials look at the effects of giving a treatment and giving no treatment, he said. The new approach is to determine the most effective treatment "so that we can tailor the treatment to individuals," Hlatky said.

The U.S. government has allocated $1.1 billion of the economic stimulus package to fund comparative effectiveness research in hopes of getting the maximum effect from dollars spent on health care.

His study pioneered in several ways, Hlatky said. Rather than looking at the end results of published studies, it pooled data on individual participants in those studies -- an idea p
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