Survival Better for Older Patients with Bypass Surgery Than Coronary Angioplasty
Largest-ever national study shows patients selected for heart bypass surgery have better long-term survival than those
opting for percutaneous coronary intervention
March 27, 2012 - Patients with coronary heart disease and their doctors have long been challenged by the decision of
whether to pursue bypass surgery or opt for the less-invasive percutaneous coronary intervention (PCI, which includes stenting and balloon
angioplasty). New evidence reveals bypass surgery appears to carry a higher long-term survival rate, according to research presented today at
the American College of Cardiology's 61st Annual Scientific Session.
The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to
further advances in the field.
The study analyzed health outcomes of 190,000 patients across the United States to compare the results of bypass surgery
to those of PCI. The study found that patients who underwent PCI had a higher death rate in the first four years after treatment than those
who had opted for bypass surgery (20.8 percent and 16.41 percent, respectively).
"Our study is the most general one ever done because it uses data from across the whole country. It is also much larger
than any other study," said William S. Weintraub, MD, chair of cardiology at Christiana Care Health System and the study's lead investigator.
"Combining data from several large databases, we found that survival was better with coronary surgery than percutaneous coronary
Dr. Weintraub cautioned that the results do not mean bypass surgery is best for every patient. "It does push the needle
toward coronary surgery, but not overwhelmingly so," said Dr. Weintraub. "When we're recommending coronary surgery to patients, even though it
is a bigger intervention than PCI, we can now have a little more confidence that the decision is a good one."
Coronary heart disease – the leading cause of death in the United States – occurs when a fatty buildup narrows or blocks
the heart's arteries. In bypass surgery, a surgeon opens the patient's chest cavity and creates a detour around the blocked artery using a
vein from another part of the body. In PCI, also known as angioplasty, a surgeon threads instruments through a small incision to clean out the
blockage and insert a wire stent, or tube, to keep the artery open (a small balloon may also be used to open the artery).
While some previous studies have suggested the two treatments have similar long-term outcomes, others have also shown
better outcomes with bypass surgery. Patients and doctors tend to choose the less-invasive PCI when both treatments are an option.
The researchers combined patient data from the American College of Cardiology Foundation CathPCI database, the Society of
Thoracic Surgeons CABG database and the Medicare claims database to compare survival rates among 86,000 bypass surgery patients and 103,000
PCI patients who underwent treatment from 2004-2008.
Dr. Weintraub says that a major limitation of observational studies, such as this one, is that the groups may not have
the same level of risk, and so it is possible that the worse outcomes in the PCI patients were related to these patients being sicker overall.
"We used sophisticated statistics to account for different levels of risk, but there may be differences between the two
groups that we could not account for," he said.
The large number of cases allowed the researchers to compare results across many subgroups. "What was a surprise to us
all was how consistent the data were no matter what analytic approach we used, and how consistent the data were across all subgroups," said
"Survival was better with coronary surgery for all patient subgroups. This study should help inform decision making
concerning the choice of revascularization in patients with stable ischemic heart disease."
This study was funded by the National Institutes of Health's National Heart, Lung and Blood Institute.
Dr. Weintraub presented the study "Survival after PCI or CABG in Older Patients with Stable Multivessel Coronary Disease:
Results from the ACCF-STS Database Collaboration on the Comparative Effectiveness of Revascularization Strategies," this morning.
This study will be simultaneously published in the New England Journal of Medicine and will be released online at
the time of presentation.
About the American College of Cardiology
The American College of Cardiology (http://www.cardiosource.org)
is a 40,000-member nonprofit medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice
managers. The College transforms cardiovascular care and improves heart health as it supports and advocates for quality improvement,
patient-centered care, payment innovation and professionalism. The ACC bestows credentials upon cardiovascular specialists who meet its
stringent qualifications and leads the formulation of health policy, standards and guidelines. It provides professional education, supports
and disseminates cardiovascular research, and operates national registries to measure and promote quality.
The ACC's Annual Scientific Session brings together cardiologists and cardiovascular specialists from around the world
each year to share the newest discoveries in treatment and prevention.
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