M
Marge
This may interest some of you.
I think this is the latest study. It is "real life" as opposed to a clinical trial.
<<Study: Heart bypass better than angioplasty
Death rates found lower for patients with clogged arteries who had major surgery.
USA Today
*
Heart patients with two or more blocked arteries live longer if they have bypass surgery than if they have their arteries cleared out with angioplasty and propped open with wire-mesh devices called stents, a major study out today says.
Doctors say the research might have profound implications for heart patients, because twice as many now undergo angioplasty to avoid the trauma of bypass surgery. That's a dramatic reversal from just a decade ago, when slightly more than a quarter of patients had angioplasty.
The study, which involved almost 60,000 patients treated from 1997 to 2000, offers the first long-term comparison of death rates for the two procedures. It found that patients were 33 percent to 56 percent more likely to die after angioplasty and stenting than after bypass surgery, reports Edward Hannan of the State University of New York in Albany.
Hannan said the analysis suggested that in just three years up to 540 "excess deaths" might have been avoided if angioplasty-and-stent patients had had bypass surgery instead.
The results, in today's New England Journal of Medicine, reflect real-life experience and not tightly controlled clinical trials. Only four prior studies compared the relative outcomes for the two procedures, and they yielded mixed results.
"This is an unexpected finding," says Timothy Gardner, medical director of the heart and vascular center at Christiana Health Care System in Wilmington, Del., who wasn't involved in the study. "The only thing I can think of is that surgery offers a benefit that we haven't picked up on in randomized trials."
Newer stents made with drug coatings might prevent tissue from growing back and clogging arteries again -- a common problem with angioplasty that forces patients to undergo repeat procedures -- but they probably would not affect death rates, Gardner says.
Hannan's team analyzed data from 37,212 bypass patients and 22,102 angioplasty patients in New York state heart registries. Within three years of the procedure, patients who had angioplasty along with the insertion of a stent consistently had higher death rates than those who had bypass surgery. In the sickest group of patients, for instance, the death rate was 15.6 percent for those who had angioplasty versus 10.7 percent for those who had bypass surgery.
"What is new is the impressive advantage of surgery," Bernard Gersh and Robert Frye of the Mayo Clinic in Rochester, Minn., wrote in an editorial in the journal, adding that "surgery may be superior in a larger group of patients than initially considered."
In 2002, U.S. doctors performed 1.2 million angioplasties, about half with stents. Surgeons performed about 515,000 bypasses, according to the latest American Heart Association statistics. >>
http://www.indystar.com/apps/pbcs.dll/article?AID=/20050526/NEWS06/505260437/1012
I think this is the latest study. It is "real life" as opposed to a clinical trial.
<<Study: Heart bypass better than angioplasty
Death rates found lower for patients with clogged arteries who had major surgery.
USA Today
*
Heart patients with two or more blocked arteries live longer if they have bypass surgery than if they have their arteries cleared out with angioplasty and propped open with wire-mesh devices called stents, a major study out today says.
Doctors say the research might have profound implications for heart patients, because twice as many now undergo angioplasty to avoid the trauma of bypass surgery. That's a dramatic reversal from just a decade ago, when slightly more than a quarter of patients had angioplasty.
The study, which involved almost 60,000 patients treated from 1997 to 2000, offers the first long-term comparison of death rates for the two procedures. It found that patients were 33 percent to 56 percent more likely to die after angioplasty and stenting than after bypass surgery, reports Edward Hannan of the State University of New York in Albany.
Hannan said the analysis suggested that in just three years up to 540 "excess deaths" might have been avoided if angioplasty-and-stent patients had had bypass surgery instead.
The results, in today's New England Journal of Medicine, reflect real-life experience and not tightly controlled clinical trials. Only four prior studies compared the relative outcomes for the two procedures, and they yielded mixed results.
"This is an unexpected finding," says Timothy Gardner, medical director of the heart and vascular center at Christiana Health Care System in Wilmington, Del., who wasn't involved in the study. "The only thing I can think of is that surgery offers a benefit that we haven't picked up on in randomized trials."
Newer stents made with drug coatings might prevent tissue from growing back and clogging arteries again -- a common problem with angioplasty that forces patients to undergo repeat procedures -- but they probably would not affect death rates, Gardner says.
Hannan's team analyzed data from 37,212 bypass patients and 22,102 angioplasty patients in New York state heart registries. Within three years of the procedure, patients who had angioplasty along with the insertion of a stent consistently had higher death rates than those who had bypass surgery. In the sickest group of patients, for instance, the death rate was 15.6 percent for those who had angioplasty versus 10.7 percent for those who had bypass surgery.
"What is new is the impressive advantage of surgery," Bernard Gersh and Robert Frye of the Mayo Clinic in Rochester, Minn., wrote in an editorial in the journal, adding that "surgery may be superior in a larger group of patients than initially considered."
In 2002, U.S. doctors performed 1.2 million angioplasties, about half with stents. Surgeons performed about 515,000 bypasses, according to the latest American Heart Association statistics. >>
http://www.indystar.com/apps/pbcs.dll/article?AID=/20050526/NEWS06/505260437/1012
