Older patients with clogged heart arteries may have a little lower death risk over time if they have bypass operations instead of angioplasty and stents to fix the problem.
In a bypass operation, doctors move healthy segments of blood vessels from other parts of the body to create detours around clogged arteries supplying blood to the heart. Angioplasty repairs the damage through a tube pushed through a blood vessel. A tiny balloon is inflated to flatten the clog and a mesh scaffold, a stent, is placed to prop the artery open.
Researchers compared these approaches using Medicare records on 190,000 patients with two or three clogged arteries — the largest study ever of this issue. Death rates were similar one year after either treatment. But after four years, nearly 21 percent of the angioplasty patients had died versus about 16 percent of those who had bypass surgery.
Doctors say differences in the overall health of people who had surgery versus the less drastic procedure could account for some of the results. They say angioplasty remains a good and safe option for many people.
"You're not making a mistake if you still have angioplasty," especially if you are over 65 with only one or two blockages, said Dr. Kirk Garratt of Lenox Hill Hospital in New York. He is a spokesman for the Society for Cardiac Angiography and Interventions, doctors who do angioplasties.
In the United States, more than a million operations or procedures are done each year to treat clogged arteries, and the study "provides comprehensive, large-scale, national data" to help doctors and patients decide which treatment is best, Dr. Susan Shurin said in a statement. She is acting director of the National Heart, Lung and Blood Institute, which sponsored the study.
Results were discussed Tuesday at an American College of Cardiology conference in Chicago and published online by the New England Journal of Medicine.
