Older patients with fatty plaque clogging several of their heart arteries are more likely to survive if they undergo bypass surgery rather than getting stents to clear the vessels and hold them open, a study found.
The data presented today at the American College of Cardiology meeting in Chicago stem from one of the first studies conducted using U.S. President Barack Obama’s 2009 stimulus funding, which provided $1.1 billion for clinical trials that compare rival therapies. The study analyzed data from 189,793 Americans ages 65 or older who received treatment in the community, providing what doctors call real-world results.
After four years, 83.6 percent of patients getting open-heart surgery were alive, compared with 79.2 percent of those treated with the less-invasive artery-clearing procedure known as angioplasty and stents made by Abbott Laboratories, Boston Scientific Corp. and Medtronic Inc. The study confirms earlier findings and gives patients more information about the long-term trade-offs of treatment, researchers said.
“This moves the bar along and may help us do things better,” though it won’t completely change care, William Weintraub, the lead researchers and chairman of cardiology at Christiana Care Health System in Newark, Delaware, said in an interview. “It is much larger than any other study, it covers the entire country” and the results apply to the general population, he said.
Each year, about 1 million Americans undergo procedures to clear their arteries, a less-invasive way of restoring healthy blood flow to the heart. The approach avoids the need to crack open the chest, a painful procedure that requires weeks of recovery. No one should underestimate the recovery time from the bypass operation, Weintraub said.
“There is fear, and there is also discounting, where people value things more upfront rather than in the distance,” he said. “Patients say I’ll take less pain now, and I’ll worry about dying in four years in four years. We should listen to patients when they say these things.”
The research found patients benefited more from bypass surgery regardless of their age, gender or other medical conditions, said Fred Edwards, a senior author of the study from the University of Florida. Those results were unexpected and should lead patients to take another look at surgery, he said in an interview.
The study, funded by the National Heart, Lung and Blood Institute, was simultaneously published in the New England Journal of Medicine.
“This is another study that suggests in people with extensive disease, surgery is a better approach,” said Douglas Weaver, chairman of cardiology at the Henry Ford Health System in Detroit, who wasn’t involved in the research. “The pendulum has been swinging that way. Doctors are saying I’m not going to try to reconstruct arteries with stents. This paper shows that’s the right direction to go.”