Bypass surgery versus angioplasty

Blocked coronary arteries can be treated successfully with either bypass surgery to get around the blockage or with angioplasty and stents to clear the blockage. However, symptoms are relieved to a greater extent with the bypass operation.Clinical trials in the early 1990s comparing coronary bypass or angioplasty showed no great difference in numbers of subsequent deaths and heart attacks. Now the results of the first trial comparing the effects of the two procedures on the health status of heart patients are being reported.Researchers from the Emory University School of Medicine in Atlanta, USA, assessed outcomes in nearly 1000 patients treated with either angioplasty and stents or by coronary bypass surgery. After six months, bypass patients had better scores on scales measuring chest pain. Similarly, at both six months and one year after the procedures, bypass patients had greater improvements than did angioplasty patients in their physical functioning scores, frequency of chest pain, and overall quality of life. Overall treatment satisfaction did not differ significantly for the two groups.

Although these results might suggest that coronary bypass should be the first choice for people with heart disease, the investigators stress that patients should have a big say in weighing the pros and cons of each option and deciding which they would prefer. For a start, not all patients do equally well on either procedure, so there's a certain amount of chance involved. Furthermore, many patients may not be willing to undergo the greater initial suffering of coronary artery bypass grafting compared with angioplasty and stenting to achieve the margin of improved health status after recovery. That is because bypass grafting usually involves splitting the chest bone and a longer recovery period than with angioplasty, which is performed through a catheter inserted into a vein. The researchers concluded that their results should be used to help with decision-making, rather than be taken as a definitive prescription for coronary bypass in all cases.