The survival rates after an angioplasty and a coronary artery bypass can be roughly the same in people with heart disease. Coronary arteries are blood vessels that supply the heart muscle with oxygen and nutrients. Fats and cholesterol can accumulate inside these arteries and the arteries can gradually become clogged. Because of this, the heart does not get adequate blood supply, which can in turn lead to heart pain (angina) or a heart attack. There are various methods to treat blocked arteries. Angioplasty and bypass are 2 such methods. Angioplasty is a procedure in which a balloon catheter (thin tube) is inserted into a blocked artery to remove the blockage. This blockage may be in an artery in the arm, leg, or in the heart. A bypass surgery usually involves 2 procedures. In the first the heart can be stopped and body supported on a heart lung machine, in which case it becomes an open-heart surgery or it may be performed on a beating heart, in which case, it is called beating heart bypass surgery. In the short-term, coronary bypass is better than angioplasty at relieving chest pain and preventing the need for a repeat procedure. On the other hand, it is also said that the risk of a stroke related to the procedure is higher with bypass grafting. To compare the efficacy of these 2 procedures, researchers at the Stanford University in California pooled data from 23 trials involving a total of 5019 heart disease patients assigned to angioplasty and 4944 assigned to coronary bypass grafting. The results showed that in comparison to angioplasty, bypass surgery was more effective in relieving angina and led to fewer repeated revascularizations but had a higher risk for procedural stroke. Survival to 10 years was similar for both procedures. Strokes occurred in 1.2 percent of patients undergoing bypass but in only 0.6 percent of those being treated with angioplasty. Angina was relieved over a five-year period in 84 percent of bypass patients compared with 79 percent of the angioplasty group. Repeat procedures were needed after five years by 43 percent of patients treated with angioplasty, whereas the rate with coronary bypass was less than 10 percent. Thus, the comparison between angioplasty and bypass continues to be moving topic of discussion and debate.
Annals of Internal Medicine,
October 2007