Web Tool to Choose Angioplasty or Surgery

Heart disease patients considering angioplasty or surgery have online tool to choose best option

(RxWiki News) Coronary bypass surgery and angioplasty are two leading treatments for heart disease. A new method may help predict which option will be best for each patient.

If the fatty, waxy substance called plaque builds up in the arteries, it blocks the flow of blood and can lead to a heart attack, heart failure or sudden death. Surgery and angioplasty are two effective means to treat the problem.

A new online tool may help doctors decide which procedure would be optimal for each patient, according to a recent study.

"Carefully assess methods for treating heart disease."

Mark Hlatky, MD, professor of medicine and of health research and policy at Stanford University in Palo Alto, California, worked with a team to develop an interactive online tool to help clinicians assess which type of intervention would increase the chances of a patient living longer.

Drawing on Medicare records of more than 100,000 patients with heart disease, the scientists observed that the results of coronary bypass surgery varied widely depending on each individual's characteristics.

Using this data, researchers found that they could evaluate patients on a half dozen traits. These traits include gender, age, diabetes status and smoking history.

Then, based on these characteristics, it could be determined if a patient would have a better outcome from surgery or angioplasty, according to Dr. Hlatky and his team.  

In addition, the scientists developed the Coronary Heart Disease Procedure Calculator. This statistical tool compares the five-year outcomes for two heart disease interventions: coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI), also called angioplasty.

Coronary bypass surgery requires a large chest incision to reach the affected arteries, and is sometimes necessary for patients with multiple blocked arteries.

Other times, the less-invasive coronary angioplasty can be performed. Angioplasty involves threading a thin tube called a catheter through the blood vessels to the site of the blockage and inflating a small balloon to widen the artery. Then, in most cases, a stent (small mesh tube) is inserted to keep the vessel open.

The online calculator is applicable to patients between the ages of 66 to 90 years with blockages in multiple arteries. The website stresses that the results are to be used for informational purposes only.

Dr. Hlatky said the study results could help doctors make better, more refined decisions about the treatments likely to be most effective for individual patients, rather than relying on medical guidelines that work best for the “typical patient.”

“If we could identify the individuals in the population who would benefit the most, and target treatment more precisely, we could have really good outcomes at much lower cost,” Dr. Hlatky said.

He added that this tool could be adapted to study other treatments for heart disease, and even treatments for other conditions, such as cancer and stroke.

The study showed that patients with severe heart disease—those who had two or more blocked arteries—lived longer, on average, when treated with coronary bypass surgery instead of angioplasty. Although, how much longer they lived varied widely.

For patients with certain conditions – including diabetes, heart failure, peripheral arterial disease, a history of smoking and a recent heart attack – coronary bypass surgery extended life by a few weeks to a few months beyond how long they would have been expected to live had they undergone angioplasty.

On the other hand, patients without any of these conditions lived longer if they had angioplasty instead of surgery.

To make accurate comparisons between procedures, Dr. Hlatky said that they tried to find “medical twins”—two people who looked alike medically, but one of whom got coronary bypass surgery and one of whom got an angioplasty. If factors such as medical condition, age, race or the part of the country they lived in were the same, then any differences in outcomes could more certainly be attributed to the procedure, according to the authors.

The study was published April 23 in the Annals of Internal Medicine.

Researchers at the University of California, San Francisco and Kaiser Permanente Northern California were also involved in the research. The study was funded by the National Heart, Lung, and Blood Institute.

Review Date: 
April 23, 2013