Longevity Better for Bypass Over PCI

Coronary bypass surgery patients live longer than angioplasty patients

(RxWiki News) Patients with clogged arteries tend to live longer when they receive coronary artery bypass surgery as compared to less-invasive percutaneous coronary intervention (PCI, or angioplasty and stenting).

Though it was surprising that the more invasive operation, which comes with longer recovery time, carries a higher survival rate, that doesn't mean every patient would do best with bypass surgery.

"Talk to your cardiologist about which procedure is most appropriate."

Dr. William S. Weintraub, chair of cardiology at Christiana Care Health System and the study’s lead investigator, said it does push the needle toward bypass surgery, but not overwhelmingly. He said the finding simply means doctors can more confidently recommend bypass over PCI in appropriate situations, knowing that the decision is a good one.

During the large observational study investigators analyzed the health outcomes of 190,000 U.S. patients who received either bypass surgery or PCI by reviewing the American College of Cardiology Foundation CathPCI database, the Society of Thoracic Surgeons CABG database and the Medicare claims database. The survival rates were reviewed for 86,000 bypass patients and 103,000 PCI patients who received treatment between 2004 and 2008.

They found that PCI patients had a 20.8 percent mortality risk in the four years after treatment as compared to a 16.4 percent risk of dying among PCI patients. The findings were similar even when investigators make comparisons across various subgroups of patients.Though PCI is often favored when there is a choice because it is less invasive, previous research has also suggested bypass patients may have better outcomes.

A limitation of the study is that patients may not have had the same levels of risk, leaving open the possibility that PCI patients were sicker overall, even though researchers adjusted the study to account for varying risk levels.

This study, funded by the National Institutes of Health’s National Heart, Lung and Blood Institute, was presented Tuesday, March 27, 2012 at the American College of Cardiology's annual scientific sessions.. It was simultaneously published in the New England Journal of Medicine.

Review Date: 
March 27, 2012