Surgery more likely than angioplasty to relieve pain in CAD patients

Source: Cleveland Clinic

Patients with mid-range coronary artery disease (CAD) are more likely to get pain relief from angina and less likely to have repeat procedures if they have bypass surgery rather than balloon angioplasty with or without a stent, according to a new study posted Monday in the online version of Annals of Internal Medicine.

The Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services (HHS), conducted the study.

AHRQ officials examined 23 randomized controlled trials that compared treatments for patients with mid-range coronary disease treatable with either angioplasty or bypass surgery. The report suggested that mid-range disease may occur in three ways: a single blockage of the vital left anterior descending artery, blockage of two arteries or some forms of less-severe blockage of three arteries.

The report, “Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting for Coronary Artery Disease,” found that mid-range coronary artery disease, bypass surgery and angioplasty patients had about the same survival rates and similar numbers of heart attacks, but bypass surgery presents a slightly higher risk of stroke within 30 days of the procedure.

“Choosing a treatment for coronary disease has long been a difficult challenge," said Carolyn Clancy, MD, AHRQ director, “But this new evidence-based report provides a vital reference to help doctors, patients, and their families make the best possible decision.”

The federal study, funded by AHRQ's Effective Health Care program and completed by its Stanford-UCSF Practice Center, compared the outcomes and risks of the procedures in patients with mid-range coronary disease, where either procedure might be chosen.

Some of the conclusions were:

• The odds of surviving either procedure are high: about 98.5 percent of patients survive beyond 30 days for both bypass surgery and angioplasty (with or without a stent).
• Long-term survival rates are comparable: about 96 percent of patients live at least one year following both procedures, and about 90 percent live five years or more.
• About 84 percent of patients who undergo bypass surgery are free of angina pain one year after the procedure, compared to 75 percent of patients who receive angioplasty. The difference narrows, but remains substantial, after five years.
• About 4 percent of patients who have bypass surgery undergo a repeat procedure within one year, and 10 percent within 5 years. It is significantly higher among patients who receive angioplasty: 24 percent more at one year and 33 percent more at five years.
• About 0.6 percent more patients receiving bypass have a stroke during the first 30 days after the procedure than patients receiving angioplasty.
• A patient’s quality of life six months to three years after undergoing the procedure found a significant improvement for bypass surgery patients than for balloon angioplasty patients. The difference, which equalizes after three years, was attributed to angina relief.