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Cleveland Clinic Study Shows Coronary Bypass Surgery is More Beneficial Than Angioplasty in High-Risk Patients
April 29, 2004

In a study performed at the Cleveland Clinic, researchers found better survival rates in high-risk patients who underwent bypass surgery than in patients who underwent angioplasty. High risk factors included coronary artery disease in multiple vessels coupled with diabetes, high blood pressure, or heart failure.

High-risk patients who underwent angioplasty or stenting (also known as percutaneous coronary interventions, or PCI), the study showed, had mortality rates nearly two times greater than did patients who had coronary artery bypass grafting (CABG) surgery. The medical records of more than 5,100 CABG patients and more than 870 PCI patients were reviewed. All patients were treated at The Cleveland Clinic between 1995 and 1999.

"Bypass surgery tended to have a greater benefit in the sickest patients," said Sorin J. Brener, M.D., first author of the Circulation study, and a staff cardiologist at The Cleveland Clinic. "Surprising results can be the most beneficial because they allow us to offer the best treatment options to patients, especially when they are contrary to conventional wisdom."

{ Click here to read the complete Cleveland Clinic article }

About Coronary Artery Bypass Grafting (CABG)

Coronary Artery Bypass Grafting (CABG), or bypass surgery, is a safe and effective way of surgically treating the symptoms of coronary artery disease. It is a procedure that reroutes the blood around a blockage in the coronary artery, creating an alternative pathway for blood to deliver important nutrients and oxygen to the heart muscle.

Blocked artery and bypass graft

Grafts are created by using portions of another artery or vein from the patient's body. The most commonly used vessels are the internal mammary arteries, which are inside the chest wall, or the greater saphenous veins, which are in the leg. These vessels are "spares." Blood flow is usually not affected by removing them. Less often, the radial artery in the arm may be used for a graft. Grafts usually last for 10 to 12 years.

About Angioplasty and Stenting

The term used to describe a procedure that opens a blocked or narrowed artery. During an angioplasty, a small wire, under x-ray guidance, is passed through a narrowed artery. A small sausage-shaped balloon is then advance over the guide wire into the narrowed section of artery, again using x-ray guidance. The balloon is then inflated to dilate the narrowed section of the artery. Once the artery is dilated, a small amount of dye is injected (angiogram) to confirm the successful dilatation.

Stent with balloon angioplasty

A stent is a device used to treat narrowing or blockage of the coronary arteries. Performed in the cardiac catherization laboratory, the stent is place by the cardiologist using x-ray guidance. The stent procedure is done with local anesthesia and mild sedation. Coronary stenting is NOT heart surgery. Stenting of the coronary artery is performed for significant narrowing of the artery that causes an impediment of blood flow down the artery. Stenting of the coronary artery is very safe, but there is a small risk to the procedure. Should stenting fail, the cardiologist may refer the patient for coronary artery bypass surgery.

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"Bypass surgery tended to have a greater benefit in the sickest patients. Surprising results can be the most beneficial because they allow us to offer the best treatment options to patients, especially when they are contrary to conventional wisdom."

Sorin J. Brener, M.D.

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