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Long-term survival same with angioplasty or bypass

In this file photo senior British cardiac surgeon Francis Wells performs a complex mitral valve reconstruction, which is transmitted live to the Wellcome Institute in London as part of a heart exhibition, at Papworth Hospital in Cambridge July 5, 2007. REUTERS/Ben Edwards

NEW YORK (Reuters Health) - For people with heart disease who need a procedure to unblock their clogged coronary arteries, angioplasty or coronary artery bypass grafting provide similar 10-year survival rates, researchers report.

However, 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, the risk of a stroke related to the procedure is higher with bypass grafting, according to the report in the Annals of Internal Medicine.

Dr. Dena M. Bravata, from Stanford University in California, and colleagues pooled data from 23 trials involving a total of 5019 heart disease patients assigned to angioplasty and 4944 assigned to coronary bypass grafting.

As mentioned, no significant difference in 10-year survival was noted between the procedures, the report indicates. This was also the case for a subgroup of diabetic patients.

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 a tad less than 10 percent.

However, because techniques continue to be refined, such a comparison “remains a moving target,” the authors point out. In particular, studies are now underway investigating how the availability of drug-coated stents used in angioplasty affects the comparative efficacy of these procedures.

SOURCE: Annals of Internal Medicine, online October 15, 2007.