In cases where drug therapy does not adequately relieve symptoms, patients have two choices: In bypass surgery, surgeons use a blood vessel harvested from the chest, leg or arm to reroute blood flow around narrowed heart arteries. In angioplasty, a catheter is used to inflate a balloon inside the plaque-narrowed artery. A mesh tube called a stent is usually inserted to keep the artery open.
For many patients, the best treatment choice is clear. For those with most extensive disease that limits blood flow in several arteries, bypass surgery is typically used. For those with the least extensive disease, less-invasive angioplasty is the standard choice. The new federal study, funded by AHRQ's Effective Health Care program and completed by the Agency's Stanford-UCSF Evidence-based Practice Center, compared the outcomes and risks of the procedures in patients with mid-range coronary disease, where either procedure might be chosen.
Among the conclusions:
-- The odds of surviving either procedure are high: about 98.5 percent of
patients survive beyond 30 days for both bypass surgery and angioplasty
(with or without a stent).
-- Long-term survival rates are likely to be comparable. About 96 percent
of patients live at least 1 year following both procedures. About 90
percent live 5 years or more. Further research is needed to clarify
survival benefits for patients at either extreme of the mid-range
-- About 84 percent of patients who undergo bypass surgery are free of
angina pain 1 year after the procedure, compared with about 75 percent
of patients who receive angioplasty. The difference narrows but remains
substantial 5 years after treatment.
-- About 4 percent of patients who have bypass surgery undergo a repeat
procedure within 1 year, and
|SOURCE Agency for Healthcare Research & Quality|
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