Study shows survival advantage for bypass surgery compared with non-surgical procedure

March 27, 2012

A new comparative effectiveness study found older adults with stable coronary heart disease (CHD) who underwent bypass surgery had better long-term survival rates than those who underwent a non-surgical procedure to improve blood flow to the heart muscle, also called revascularization.

The National Institutes of Health-supported study compared a type of surgery known as (CABG) with a non-surgical procedure known as percutaneous coronary intervention (PCI). While there were no survival differences between the two groups after one year, after four years the CABG group had a 21 percent lower mortality.

Principal investigator William Weintraub, M.D., of Christiana Care Health System in Newark, Del., and colleagues will present these findings on Tuesday, March 27, at the American College of Cardiology's annual meeting in Chicago. The findings will appear online today in the and in the April 19 print issue. Two companion papers that describe the statistical prediction models used to forecast long-term survival rates will also appear in today's print issue of Circulation.

"In the United States, cardiologists perform over a million a year to open blocked arteries. This study provides comprehensive, large-scale, national data to help doctors and patients decide between these two treatments," said Susan B. Shurin, M.D., acting director of the NIH's National , Lung, and Blood Institute (NHLBI), which funded the study.

Comparative effectiveness research results provide information to help patients and decide which practices are most likely to offer the best approach for a particular patient, what the timing of interventions should be, and the best setting for providing care.

In CHD, also called , plaque builds up inside the coronary arteries that supply blood to the heart muscle. Over time, blocked or reduced blood flow to the heart muscle may occur, resulting in chest pain, heart attack, heart failure, or erratic heart beats. Each year, more than half a million Americans die from CHD.

In CABG, or bypass surgery, the most common type of heart surgery in the United States, blood flow to the heart muscle is improved by using ("grafting") a healthy artery or vein from another part of the body to bypass the blocked .

PCI is a less invasive, non-surgical procedure in which blocked arteries are opened with a balloon (also called angioplasty). A stent, or small mesh tube, is then usually placed in the opened arteries to allow blood to continue to flow into the .

With NHLBI support, the American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS) came together to compare short- and long-term survival outcomes after CABG versus PCI. The investigators linked medical data available in their ACCF and STS databases with follow-up information in the Medicare Provider Analysis and Review database of the Centers for Medicare and Medicaid Services.

Linking these three datasets from 644 U.S. hospitals allowed researchers to analyze information from the STS database on 86,244 older adults (average age 74) with stable CHD who underwent CABG between 2004 and 2007 and 103,549 older adults (average age 74) with stable CHD from the ACCF database who underwent PCI between 2004 and 2007. Follow-up ranged from one to five years, with an average of 2.72 years.

At one year there was no difference in deaths between the groups (6.55 percent for PCI versus 6.24 percent for CABG). However, at four years there was a lower mortality with CABG than with PCI (16.41 percent versus 20.80 percent). This long-term survival advantage after CABG was consistent across multiple subgroups based on gender, age, race, diabetes, body mass index, prior heart attack history, number of blocked coronary vessels, and other characteristics. For example, the insulin-dependent diabetes subgroup that received CABG had a 28 percent increased chance of survival after four years compared with the PCI group.

"This landmark data-sharing collaboration between the American College of Cardiology Foundation, the Society of Thoracic Surgeons, and the Duke Clinical Research Institute allowed researchers to conduct the most comprehensive real-world observational study on this topic to date," said Michael Lauer, M.D., director of the NHLBI Division of Cardiovascular Sciences.

Explore further: Study shows drop off in coronary artery bypass surgeries for heart patients

More information: www.nhlbi.nih.gov/health/health-topics/topics/cad/

Related Stories

Study shows drop off in coronary artery bypass surgeries for heart patients

May 3, 2011
New research from the University of Pennsylvania School of Medicine shows a substantial decrease in one type of revascularization procedure, coronary artery bypass graft (CABG) surgery, while rates of utilization of the other ...

Mitral valve repair with bypass surgery may improve heart function

February 29, 2012
Patients who had leaky mitral heart valves repaired along with bypass surgery had with healthier hearts than those who had bypass only, according to new research presented in the American Heart Association's Emerging Science ...

Variations in cardiac procedures related to physician recommendations and hospital characteristics

December 12, 2011
Physician preferences and hospital characteristics influence the type of procedures performed on blockages of the heart, leading to significant variations in rates of bypass, stent or angioplasty procedures, found an article ...

Positive results for unprotected left main coronary artery PCI with drug-eluting stents

June 22, 2011
Patients with normal left ventricular function who undergo elective unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with drug-eluting stents (DES) had favorable outcomes according to ...

Recommended for you

Hormone therapy in the menopause transition did not increase stroke risk

November 24, 2017
Postmenopausal hormone therapy is not associated with increased risk of stroke, provided that it is started early, according to a report from Karolinska Institutet published in the journal PLOS Medicine.

Low-salt and heart-healthy dash diet as effective as drugs for some adults with high blood pressure

November 22, 2017
A study of more than 400 adults with prehypertension, or stage 1 high blood pressure, found that combining a low-salt diet with the heart-healthy DASH diet substantially lowers systolic blood pressure—the top number in ...

Stroke patients may have more time to get treatment, study finds

November 22, 2017
Patients and doctors long have relied on a simple rule of thumb for seeking care after an ischemic stroke: "Time is brain."

Cases of heart failure continue to rise; poorest people worst affected

November 22, 2017
The number of people being diagnosed with heart failure in the UK continues to rise as a result of demographic changes common to many developed countries, new research by The George Institute for Global Health at the University ...

Some cancer therapies may provide a new way to treat high blood pressure

November 20, 2017
Drugs designed to halt cancer growth may offer a new way to control high blood pressure (hypertension), say Georgetown University Medical Center investigators. The finding could offer a real advance in hypertension treatment ...

Could this protein protect people against coronary artery disease?

November 17, 2017
The buildup of plaque in the heart's arteries is an unfortunate part of aging. But by studying the genetic makeup of people who maintain clear arteries into old age, researchers led by UNC's Jonathan Schisler, PhD, have identified ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.