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Coronary bypass surgery results in better 5-year outcomes than coronary angioplasty

Previous studies have not shown any substantial difference in how coronary artery disease (CAD) patients fare 2 to 3 years after either coronary artery bypass graft (CABG) surgery or percutaneous transluminal coronary angioplasty (PTCA), two procedures that are performed to restore adequate blood supply to blocked arteries. However, a recent meta-analysis performed by researchers at Tufts-New England Medical Center in Boston found that more CABG patients than angioplasty patients were alive 5 years later, and they had less angina (crushing chest pain) and fewer additional revascularization procedures than PTCA patients.

Yet, only 35 percent of PTCA patients had stents inserted during the initial procedures. Stents are expandable metal mesh tubes that are inserted during angioplasty, a procedure in which a balloon-tipped catheter is threaded through the blocked coronary artery. The balloon is inflated to flatten plaque against the arterial walls to reestablish cardiac blood flow. Placed at the site of the blockage, the stent pushes against the artery wall to keep it open after the surgery. The addition of stents and newer adjunctive therapies may improve outcomes for PTCA relative to CABG, but long-term data are not yet available, note the researchers who conducted the study. Their work was supported in part by the Agency for Healthcare Research and Quality (HS06503).

The meta-analysis involved 13 randomized trials on 7,964 patients comparing PTCA with CABG. The researchers found a 1.9 percent absolute survival advantage favoring CABG over PTCA for all trials at 5 years but no significant advantage at 1, 3, or 8 years. Patients randomized to PTCA had more repeat revascularization procedures at all time points. However, the addition of stents reduced the need for repeat revascularization by about half and resulted in a significant decrease in nonfatal heart attack at 3 years compared with CABG.

See "A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: One- to eight-year outcomes," by Stuart N. Hoffman, D.O., John A. TenBrook Jr., M.D., Michael P. Wolf, M.D., and others, in the April 16, 2003, Journal of the American College of Cardiology 41(8), pp. 1293-1304.

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