Heart Smart Treatment

Patients with severe coronary-artery disease live longer if they receive coronary artery bypass surgery as their initial treatment instead of artery-opening angioplasty or heart medications, according to a study by Duke Medical Center researchers. Yet up to 40 percent of patients diagnosed with severe coronary disease are treated first with angioplasty or medications and not given the opportunity to receive bypass surgery, the researchers estimate. Bypass surgery is more expensive and more invasive, but has the benefit of increasing patient life span significantly more than the other options.

Bypass surgery involves opening the chest and surgically bypassing blockages in coronary arteries with healthy arteries taken from other parts of the body, most often the legs. Angioplasty involves snaking an expandable balloon through a tube inserted into a blocked coronary artery and then expanding the balloon to push the blockage against the walls of the artery, thereby opening it.

"It may sound very appealing to patients with severe coronary artery disease to get a treatment that is less expensive or less invasive, but they may not be getting the same survival benefit as those patients receiving bypass surgery," says Peter Smith, chief of cardiothoracic surgery and lead investigator for the study. "The forty-year history of bypass surgery has shown it to be a durable and reliable treatment for coronary-artery disease," he says. "It may seem counterintuitive to start a patient on the most invasive treatment option, but our analysis showed that surgery provided significant improvement in longevity for patients with severe disease."

Smith also points out that his group's study has the strength of having analyzed patients who are representative of the general population of heart patients, so the results showing long-term benefits of bypass surgery should be widely applicable.

By contrast, he says, cardiologists' widespread use of angioplasty and stents is based on the results of clinical trials in which patients are carefully screened before being allowed to participate. The findings of the study appeared in the Journal Annals of Thoracic Surgery.