Coronary Bypass Surgery Increases Freedom From Angina More Than Angioplasty
En Español (Spanish Version)

Angina is chest pain with activity or exertion. It is caused by blockages in the arteries that supply blood to your heart. Blockages are caused by smoking, diabetes , high blood pressure , and high cholesterol . If you suffer from angina, you have probably had long discussions with your doctor about treatment options. Deciding to have major coronary artery bypass graft (CABG) surgery or a simpler percutaneous coronary intervention (PCI) is not easy.

A study published in the Annals of Internal Medicine may help you and your doctor make that decision. The study is a large review of the results after CABG and PCI. Patients who underwent CABG had less symptoms of angina at one year and five years after surgery.

About the Study
The researchers looked at results from 23 high quality studies comparing CABG and PCI in almost 10,000 patients between 1987 and 2002. There were two types of PCI included; some patients had the earlier balloon angioplasty and some had the more recent procedure with the artery stent. Time of patient follow-up ranged from 6 months to 13 years. The mean age of patients was 61 years old, and 27% were women. There were patients with diabetes (20%), high blood pressure (50%), high cholesterol (50%), and a history of heart attack (40%).

Both procedures had good five-year survival rates: 90.7% with CABG vs. 89.7% with PCI. Before stents were used in PCI, CABG had a better survival rate, but there was no significant difference in survival after PCI included stents. PCI was associated with a lower rate of stroke within 30 days of the procedure, but the rates were very small in both procedures: 1.2% in CABG vs. 0.6% in PCI.

Based on the studies, CABG is favored over PCI due to 1) the improvement in symptoms of angina and 2) less repeat procedures.

After one year, 84% of patients who had CABG were angina-free and only 3.8% had another procedure. While 75% of the patients who had PCI were angina-free and 26 % had another procedure.

After five years, 84% of patients who had CABG were angina-free and only 9.8% had another procedure. While 79% of the patients who had PCI were angina-free and 40% had another procedure.

How Does This Affect You?
Heart disease is still the number one cause of death in the United States. Coronary artery disease causes much disability and illness. Treatment options include diet, exercise, smoking cessation, and medications to control blood pressure, cholesterol, and diabetes. When lifestyle changes and medications are not controlling your symptoms, your doctor may decide on surgery. This study reports encouraging results from coronary artery bypass surgery over many years. Remember, before undergoing any medical procedure, be sure you understand the risks and benefits. Always discuss these risks with your physician when deciding which procedure is best for you.




RESOURCES:
American Heart Association


References:
Bravata DM, Gienger AL, McDonald KM, Sundaram V, Perez MV, Varghese R, et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med . 2007 Nov 20;147(10):703-16. Epub 2007 Oct 15.

Last Reviewed December 2007



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