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Bypass Surgery, a Better Option than Angioplasty for Severe Heart Patients

utcomes of 18,481 patients who had at least one coronary artery that was more than 75 percent blocked and who had received bypass surgery, angioplasty or heart medications at Duke from 1986 to 2000. Patients were considered to have severe coronary artery disease if three of their coronary arteries were more than 75 percent blocked.

Patients were divided into three groups, depending on when they were treated: 1986-1990, 1991-1995 and 1996-2000. The final period is most important, the researchers said, because 1996 was when physicians first began inserting stents during angioplasty procedures.

Stents are thin metal mesh tubes that are inserted at the site of a blockage after angioplasty to keep the artery open. For cardiologists, stents were a significant advance over angioplasty alone, cutting in half the rate of reblockage of the treated artery, Smith said. More than three-quarters of patients undergoing angioplasty now receive stents.

The study period ended before "drug-eluting stents," the latest generation of stents that slowly release drugs to keep the treated artery open, came into use.

"We believe that our findings have a particular relevance to practice today, since recent studies are suggesting that there may be problems with the long-term durability of drug-eluting stents," Smith said. "Because of these new questions, many physicians are going back to the traditional stents."

The researchers found that patients in the 1996-2000 period with severe disease who received bypass surgery lived an average of 5.3 months longer than those treated by angioplasty, a statistically significant difference.

"These findings should change practice," Smith said. "We've clearly needed the long-term survival data, and this study provides it. Patients receiving bypass surgery get a durable fix for their disease. Patients undergoing angioplasty with a stent not only have a foreign object in their body, but t
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