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

roposed in 1995 by Stuart Pocock of the London School of Hygiene and Tropical Medicine and senior author of the report.

The studies analyzed in the new report were done before the use of drug-coated stents, the flexible tubes implanted after PCI, had become common. But Hlatky noted that that did not affect the conclusions of the report.

"Every comparison of coated stents and bare-metal stents has shown no difference in mortality," he said. "The difference is in the number of repeat procedures required."

Some cardiologists have been reluctant to perform bypass surgery, because it carries more immediate risk than PCI. The study found a 1 percent incidence of complications from bypass procedures, compared with half of 1 percent for PCI. But Hlatky said that difference is overwhelmed by the long-term survival data.

"We know you have a higher risk upfront," he said. "You are willing to take that risk if you know the longer outcome is more favorable."

The diabetes finding "is not terribly surprising," said Dr. L. David Hillis, chairman of the department of medicine at the University of Texas Health Science Center in San Antonio. Studies reporting improved survival with surgery in diabetics were published as long as 10 years ago, and the U.S. National Heart, Lung, and Blood Institute is starting a study to confirm those findings, Hillis said.

He described the reported benefit of surgery in older people as "somewhat surprising, because you would think that, as people grow older, the risk of surgery goes up -- so this is the opposite of what you would predict."

But the definition of "old" in the new study provides one possible explanation, Hillis said. "There were almost no patients over the age of 75," he said. "They are talking about people ages 65 to 75. There were no really very old people in the study."

Another possible explanation is that older people are likely to have more extensive block
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